Torticollis
Torticollis, also known as spasmodic torticollis or wryneck, is a condition characterized by involuntary contractions of the neck muscles, leading to abnormal movements and postures of the head. This form of dystonia can manifest as the head tilting backward, forward, or sideways. The exact causes of torticollis remain largely unknown, though some instances may have genetic links, while others can result from nerve damage affecting the neck muscles. Symptoms often include muscle spasms, neck pain, tingling, and headaches, and these can vary from short-term episodes to chronic conditions.
Torticollis can occur in both sexes and may start in childhood or adulthood. Treatment options typically involve drug therapy and physical therapy, with varying degrees of success. In some cases, botulinum toxin injections have been effective for managing symptoms. While surgery is not generally the first line of treatment, it may be considered for patients who do not respond to other therapies. Early intervention tends to yield better outcomes, especially in younger individuals, although chronic cases might lead to lasting head tilt or rotation. Understanding the nature of torticollis can help those affected seek appropriate care and support.
Torticollis
ALSO KNOWN AS: Spasmodic torticollis, wryneck
ANATOMY OR SYSTEM AFFECTED: Muscles, neck
DEFINITION: A form of dystonia (muscle rigidity) in which the neck muscles contract involuntarily, causing spasms, abnormal movements, and posture of the neck and head backward (retrocollis), forward (antercollis), or sideways (torticollis).
CAUSES: Unknown; possibly genetic
SYMPTOMS: Muscle spasms, abnormal movements and posture of neck and head, tingling and numbness, headaches
DURATION: Short-term to chronic
TREATMENTS: Drug therapy, physical therapy
Causes and Symptoms
Torticollis occurs equally in the sexes and may develop in childhood or adulthood. Its causes are unknown, but some cases seem to be genetic, while others are acquired from secondary damage to the nerves affecting the head or neck muscles. Congenital torticollis may be caused at birth by malpositioning of the head in the or by prenatal injury of the muscles or blood supply in the neck. Torticollis results from abnormal functioning of the basal ganglia, situated at the base of the brain, which control all coordinated movements.
The first symptoms may appear gradually as the head tends to rotate or turn to one side involuntarily. Other symptoms may involve asymmetry of an infant’s head from sleeping on the affected side, enlargement or stiffness of the neck muscles, limited range of head motion, neck pain, and even headaches.
Treatment and Therapy
Because the cause of torticollis is unknown in most cases, presently no certain cure exists. Drug therapy is frequently employed, but these medications often produce only unpredictable, short-term benefits. Some patients experience relief when treated by physiotherapists, who may use local moist heat, ice, ultrasonography, or a custom-fitted soft collar. Surgery is not recommended as an initial treatment, but it has proven helpful in cases unresponsive to medication. Botulinum toxin injections for spasmodic torticollis or trigger point injections for pain management have proven effective.
Perspective and Prospects
Torticollis is easiest to correct in infants and children and in adults who receive early treatment. With chronic conditions, tingling and may develop as nerve roots in the cervical become depressed. Recent innovative surgical procedures are helpful, but they are not a complete cure for chronic spasmodic torticollis. Patients with long-term torticollis will probably retain some degree of head tilt or rotation.
Bibliography:
American Medical Association. American Medical Association Family Medical Guide. 4th rev. ed. Hoboken, N.J.: John Wiley & Sons, 2004.
"Dystonias Fact Sheet." National Institute of Neurological Disorders and Stroke, February 21, 2013.
Litin, Scott C., ed. Mayo Clinic Family Health Book. 4th ed. New York: HarperResource, 2009.
Moore, Keith L., and Arthur F. Dalley II. Clinically Oriented Anatomy. 6th ed. Philadelphia: Kluwer/Lippincott Williams & Wilkins, 2010.
Nagler, Willibald. “Rehabilitating a Stiff Neck.” Family Practice News 36, no. 3 (February 1, 2006): 38.
National Library of Medicine. "Torticollis." Medline Plus, 25 Apr. 2022, medlineplus.gov/ency/article/000749.htm. Web. Accessed 8 Apr. 2024.
Noback, Charles R., et al. The Human Nervous System: Structure and Function. 6th ed. Totowa, N.J.: Humana Press, 2005.
Pathak, Mayank, Karen Frei, and Daniel Truong. The Spasmodic Torticollis Handbook: A Guide to Treatment and Rehabilitation. New York: Demos Health, 2003.
Savitsky, Diane. "Torticollis." Health Library, November 26, 2012.
Tomczak, Kinga K., and N. Paul Rosman. "Torticollis." Journal of Child Neurology 28, no. 3 (March 2013): 365–78.