Torticollis

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Torticollis (wry neck)
Torticollis (also called Wryneck or Cervical
Dystonia) is one of a broader category of
disorders that exhibit ?exion, exten- sion, or
twisting of muscles of the neck beyond their
normal position. In torticollis, the neck tends
to twist to one side, causing head tilt. The
condition can either develop slowly if you have a
family history of the disorder, or acutely from
trauma, or as an adverse reaction to
medications. When the disorder occurs in people
with a family history, it is referred to as
spasmodic torticollis. The characteristic
twisting of the neck is initially spasmodic and
begins between 31-50 years of age. If you leave
the condition untreated, it likely will become
permanent. Bending or twisting your neck too far
can lead to acute torticol- lis. This condition
appears with few symptoms, although often you
will appear uncomfortable and will hold your head
straight or rotated to one side. It will hurt to
move your head to the opposite side. Your neck
muscles on the side that hurts often are tender
to the touch. The doctor will check your nerve
and motor function to rule out spinal cord
injury.?
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Causes and Risk factors

• In adults, acute torticollis can be caused by
  many di?erent conditions. Occasionally, no
  condition is found as a cause.
• Trauma to the neck or spine can lead to
  torticollis. Injuries to the cervical spine or
  neck muscles often result in spasm of the
  muscles, leading to the twisting of the head,
  characteristic of torticollis.
• Other causes include infection of the head or
  neck. These infections can cause an in?ammatory
  torticollis secondary to in?amed glands and lymph
  nodes in the neck. The muscles overlying these
  lymph nodes contract. Torticollis may be
  associated with abscesses of the throat and upper
  airway, and those situations can be life-
  threatening. Other infections of the sinuses,
  ears, mastoids, jaw, teeth, or scalp can lead to
  torticollis.
• Rarely, tumors, scar tissue, arthritis of the
  cervical spine, or vascular abnormalities may
  also cause torticollis.
• Certain drugs of abuse such as ketamine,
  amphetamines, and cocaine as well as commonly
  prescribed neuroleptic drugs such as
  prochlorperazine (Compazine),haloperidol
  (Haldol), and chlorpromazine (Thorazine) can
  cause acute dystonia (a lack of normal muscle
  control). This is a condition that involves the
  sudden onset of involuntary contractions of the
  muscles of the face, neck, or back.
• In addition to bending of the head to one side
  (acute torticollis), you may experience deviation
  of the eyes (oculogyric crisis) and protrusion of
  the tongue (buccolingual crisis). In addition to
  the causes above, children, infants, and newborns
  may also acquire torticollis from congenital
  causes or trauma due to childbirth. Congenital
  muscular torticollis is the most common cause of
  torticollis in infants.
• Risk factors for torticollis include
• AGE. While the disorder can occur in people of
  any age, even children, it most commonly begins
  between the ages of 40 and 70.
• SEX. Women are more likely to develop torticollis
  than are men.
• FAMILY HISTORY. If a close family member has
  torticollis or some other type of dystonia, you
  are at higher risk of develop- ing the disorder.
• Risk factors for torticollis also include
  congenital abnormalities of the cervical spine,
  taking drugs that predispose to muscular spasm,
  and trauma.

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Symptoms
Because spasmodic torticollis is an abnormal
contraction of the muscle in one side of the
neck, people will appear with their head turned
to one side. Neck muscles and those between the
neck and shoulder will be tense and
tender. People with acute torticollis will be
unwilling to turn their head to one side or may
have their head turned slightly away from the
side of discomfort. Other symptoms may include
shoulder pain, back pain, headache, neck cramps,
muscle tightness, or burning sensations
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Diagnosis
The doctor will take a detailed history
emphasizing speci?c medications that you may be
taking. A physical examination will be
performed. When there is a history of trauma, the
doctor may take X-rays of your neck to exclude a
fracture or dislocation of the spinal bones in
your neck. Often, X-rays are su?cient to make
this determination. In a small number of cases,
subtle abnormalities or preex- isting conditions,
for example, degenerative arthritis of the spine
or of the neck may require a CT scan.

• Tests may also include
• Blood or urine tests. These may reveal the
  presence of toxins.
• Magnetic resonance imaging (MRI). This type of
  imaging test may be used to identify and
  visualize tumors or evidence of
• stroke.
• Electromyography (EMG). This test measures the
  electrical activity of muscles. EMG helps
  evaluate and diagnose muscle and nerve disorders
  and can help con?rm whether you have cervical
  dystonia or another condition.

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Non-surgical Treatment

• Treatment for torticollis is targeted to relax
  the contracted neck muscles involved.
• MEDICATIONS
• People who have cervical dystonia (torticollis)
  often must use a combi- nation of medications to
  reduce their signs and symptoms.
• Botulinum toxin. This paralyzing agent, often
  used to smooth facial wrinkles, can be injected
  directly into the neck muscles a?ected by
  cervical dystonia. Examples of botulinum toxin
  drugs include Botox, Dysport, Xeomin and Myobloc.
  Most people with cervical dystonia see an
  improvement with this treatment, which usually
  must be repeated every three to four months.

• Parkinson's drugs. Medications used to combat the
  tremors associated with Parkinson's disease may
  be used in combination with botulinum toxin
  injections. Frequent side e?ects include dry
  mouth, constipation, memory problems, reduced
  urinary stream or visual blurring.
• Muscle relaxants. These drugs often help a
  little, but also have side e?ects, most notably
  sedation, imbalance and mild cognitive
  impairment. Examples include diazepam (Valium,
  Diastat), lorazepam (Ativan), clonazepam
  (Klonopin) and baclofen (Lioresal, Gablofen).
• Pain medications. The pain from cervical dystonia
  may require drug treatment. This may range from
  over-the- counter pain relievers to prescription
  pain medications.

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Non-surgical Treatment

• PHYSICAL THERAPY
• The signs and symptoms of torticollis are
  sometimes eased by
• Exercises that improve neck strength and
  ?exibility Judicious use of a neck brace
• Training in stress management techniques

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Surgical Treatment

• If less invasive treatments don't help, your
  doctor may suggest surgery.
• Cutting muscles or nerves. Surgery to cut the
  nerves or muscles responsible for the contorted
  posture associated with cervical dystonia can be
  performed to help those who no longer get bene?t
  from botulinum toxin or medications. This is
  called selective denervation surgery and isn't
  widely available.
• Deep brain stimulation (DBS). In this surgical
  procedure, a thin wire is guided into the brain
  through a small hole cut into the skull. The tip
  of the wire is placed in the portion of the brain
  that controls movement. Electrical pulses are
  sent through the wire to interrupt the nerve
  signals making your head twist. DBS is used only
  in the most di?cult of cervical dystonia cases.

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Usefull advice

• For the great majority of people with acute
  torticollis, the condition goes away in several
  days to a few weeks. A small number of people
  will go on to develop continuing problems with
  their neck for months to years.
• If symptoms are limited to muscle sti?ness and
  pain, see your doctor in at least a day.
• If you injure your neck and have spasm of the
  muscles, go immediately to a hospital's emergency
  department. You can do a number of things at home
  to ease your pain
• Reduce stress. Avoiding situations that cause
  stress or anxiety is important because stress
  tends to make your signs and symptoms worse.

• Get your rest. Signs often disappear during
  sleep, so get plenty of rest. You may ?nd relief
  by taking short breaks during your day to lie on
  your back and relax.
• Use heat. Heat packs may help loosen the taut
  muscles in your neck and help with pain relief.
• Try touching. Sensory tricks, such as touching
  the opposite side of your face or the back of
  your head, may cause spasms to stop temporarily.
  Di?erent sensory tricks work for di?erent people,
  and if you ?nd one that works, it usually will
  continue to work for you.