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Torticollis

Torticollis is a condition in which the neck muscles cause the head to turn or rotate to the side.

Alternative Names

Spasmodic torticollis; Wry neck; Loxia; Cervical dystonia

Causes

Torticollis may be:

  • Inherited -- due to changes in your genes
  • Acquired -- develops as a result of damage to the nervous system, upper spine, or muscles

If the condition occurs without a known cause, it is called idiopathic torticollis.

Torticollis may develop in childhood or adulthood. Congenital torticollis (present at birth) may occur if the baby's head was in the wrong position while growing in the womb, or if the muscles or blood supply to the neck were injured.

Symptoms

  • Limited range of motion of the head
  • Headache
  • Head tremor
  • Neck pain
  • Shoulder that is higher than the other
  • Stiffness of the neck muscles
  • Swelling of the neck muscles (possibly present at birth)

Exams and Tests

Tests or procedures may be done to rule out possible causes of head and neck pain. A physical exam will show:

  • Abnormal position of the head that makes it rotate, tilt, or lean forward or back. Many people have more than one abnormal head position.
  • Shortened or larger neck muscles
  • The entire head pulls and turns to one side (in more severe cases)

Tests that may be done include:

Treatment

Treating torticollis that is present at birth involves stretching the shortened neck muscle. Passive stretching and positioning are used in infants and small children. In passive stretching, something is used to hold the body part in a certain position. This could be a device such as a strap, a person, or something else. These treatments are often successful, especially if they are started within 3 months of birth.

Surgery to correct the neck muscle may be done in the preschool years, if other treatment methods fail.

Torticollis that is caused by damage to the nervous system, spine, or muscles is treated by finding the cause of the disorder and treating it. Depending on the cause, treatment may include:

  • Applying heat, traction to the neck, and massage to help relieve head and neck pain
  • Stretching exercises and neck braces to help with muscle spasms
  • Taking medications such as the drug baclofen to reduce neck muscle contractions
  • Injecting botulinum toxin every 3 months
  • Surgery of the spine might be needed when the torticollis is due to dislocated vertebrae. In some cases, surgery involves destroying some of the nerves in the neck muscles, or using brain stimulation.

Outlook (Prognosis)

The condition may be easier to treat in infants and children. If torticollis becomes chronic , numbness and tingling may develop due to pressure on the nerve roots in the neck.

The neck muscle may become large (hypertrophic) due to constant stimulation and exercise.

Possible Complications

Complications may include:

  • Muscle swelling due to constant tension
  • Nervous system symptoms due to pressure on nerve roots

When to Contact a Medical Professional

Call for an appointment with your health care provider if symptoms do not improve with treatment, or if new symptoms develop.

Torticollis that occurs after an injury or with illness may be serious. Seek medical help right away if this occurs.

Prevention

While there is no known way to prevent this condition, early treatment may prevent it from getting worse.

References

Patel M, Shah K. Orthopedics. In: Rakel RE, ed. Textbook of Family Medicine. 8th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 31.

Persing J. Prevention and management of positional skull deformities in infants. American Academy of Pediatrics Committee on Practice and Ambulatory Medicine, Section on Plastic Surgery and Section on Neurological Surgery. Pediatrics. 2003;112:199-202.

Spiegel DA, Hosalkar HS, Dormans JP, Drommond DS. The neck. In: Kliegman RM, Stanton BF, St. Geme JW III, Schor NF, Behrman RE, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap. 672.

Updated: 5/20/2014

Joseph V. Campellone, MD, Division of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.


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