Torticollis

Infobox_Disease
Name = Torticollis



Caption = A Guinea pig with wry neck
DiseasesDB = 31866
ICD10 = ICD10|M|43|6|m|40
ICD9 = ICD9|723.5
ICDO =
OMIM =
MedlinePlus =
eMedicineSubj = emerg
eMedicineTopic = 597
eMedicine_mult = eMedicine2|orthoped|452 | MeshID = D014103

Torticollis, or Requa neck, is a condition in which the head is tilted toward one side, and the chin is elevated and turned toward the opposite side.

In children

Torticollis can be congenital or acquired.

Congenital muscular torticollis

The etiology of congenital muscular torticollis is unclear. Birth trauma or intrauterine malposition is considered to cause damage to the sternocleidomastoid muscle in the neck. Fact|date=June 2008 This results in a shortening or excessive contraction of the sternocleidomastoid muscle, often with limited range of motion in both rotation and lateral bending. The head is typically tilted in lateral bending toward the affected muscle and rotated toward the opposite side.

The reported incidence of congenital torticollis is 0.3-2.0 %. [Cheng JCY, Wong MWN, Tang SP, Chen TMK, MPhil, Shum SLF, Wong EMC. Clinical determinants of the outcome of manual stretching in the treatment of congenital muscular torticollis in infants. Bone Joint Surg. 2001;83:679-687.] Sometimes a mass (a sternomastiod tumor) in the affected muscle may be noted, this appears at the age of two to four weeks, it disappears gradually, but sometimes the muscle becomes fibrotic. It is likely to disappear within the first five to eight months of life.

The condition is treated with chiropractic care, physical therapy, with stretching to correct the tightness, strengthening exercises to achieve muscular balance, handling to stimulate symmetry. A TOT Collar is sometimes used. About 5–10% require surgery, [Tang SF, Hsu KH, Wong AM Hsu CC, Chang CH. Logitudinal followup study of ultrasonography in congenital muscular torticollis. Clin Orthop. 2002;403:179-185.] [Hsu TC, Wang CL, Wong MK, Hsu KH, Tang Ft, Chen Ht. Correlation of clinical and ultrasonographic features in congenital muscular torticollis. Arch Phys Med Rehabil. 1999;80:637-641.] "surgical release" of the muscle if stretching fails.

Infants with torticollis have a higher risk for plagiocephaly. Altering the head position and using a pillow when supine helps as does giving a lot of tummy time when awake.

Other less common causes such as tumors, infections, ophthalmologic problems and other abnormalities should be ruled out. For example, ocular torticollis due to cranial nerve IV palsy should not be treated with physical therapy. In this situation, the torticollis is a neurologic adaptation designed to maintain binocularity. Treatment should be targeted at the extraocular muscle imbalance.

In general, if torticollis is not corrected facial asymmetry can develop. Fact|date=June 2008 Head position should corrected before adulthood (to about the age of 18 there can be improvement). Younger children show the best results.

Congenital torticollis develops in the infant but can be diagnosed at older ages, even in adults who were missed as infants/children.

The word torticollis means wry neck: Acquired torticollis is not the same as congenital torticollis. All ages can suffer from acquired torticollis.

A common, but effective, treatment involves a multi-phase process:
1) Low-impact exercise to increase strong form neck stability
2) Repetitive shiatsu massage
3) Extended heat application

Acquired torticollis

Infobox_Disease
Name = Torticollis (illustration)


Caption = Torticollis demonstrated by Mr. Bean's Teddy
Acquired torticollis occurs because of another problem and usually presents in previously normal children.

* Trauma to the neck can cause atlantoaxial rotatory subluxation, in which the two vertebrae closest to the skull slide with respect to each other, tearing stabilizing ligaments; this condition is treated with traction to reduce the subluxation, followed by bracing or casting until the ligamentous injury heals.
* Tumors of the skull base (posterior fossa tumors) can compress the nerve supply to the neck and cause torticollis, and these problems must be treated surgically.
* Infections in the posterior pharynx can irritate the nerves supplying the neck muscles and cause torticollis, and these infections may be treated with antibiotics if they are not too severe, but could require surgical debridement in intractable cases.
* Ear infections and surgical removal of the adenoids can cause an entity known as Grisel's syndrome, a subluxation of the upper cervical joints, mostly the atlantoaxial joint, due to inflammatory laxity of the ligaments caused by an infection. This bridge must either be broken through manipulation of the neck, or surgically resected.
* The use of certain drugs, such as antipsychotics, can cause torticollis. [http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&uid=16208529&cmd=showdetailview&indexed=google]
* There are many other rare causes of torticollis.

Evaluation

Evaluation of a child with torticollis begins with history taking to determine circumstances surrounding birth and any possibility of trauma or associated symptoms. Physical examination reveals decreased rotation and bending to the side opposite from the affected muscle. Some say that congenital cases more often involve the right side, but there is not complete agreement about this in published studies. Evaluation should include a thorough neurologic examination, and the possibility of associated conditions such as developmental dysplasia of the hip and clubfoot should be examined. Radiographs of the cervical spine should be obtained to rule out obvious bony abnormality, and MRI should be considered if there is concern about structural problems or other conditions.

Evaluation by an ophthalmologist should be considered in children to ensure that the torticollis is not caused by vision problems (IV cranial nerve palsy, nystagmus-associated "null position," etc.). Most cases in infants respond well to physical therapy. Other causes should be treated as noted above.

In adults

Wry Neck can also occur in adults for various reasons, such as an injury to the neck or simply sleeping in an awkward position. One may find that upon awakening it is extremely difficult to lift one's head or is extremely painful to move it.

Doctors will normally prescribe an anti-inflammatory, but the pain will subside on its own given time. Once the severity of the pain begins to lessen, gentle and increasing movement of the head should begin to restore the full range of motion.

It is also possible to have a muscle relaxant injected into the body to help speed recovery.

In animals

The condition can also occur in animals, usually as a result of an inner ear infection but sometimes as a result of an injury. It is seen largely in domestic rodents and rabbits, but may also appear in dogs and other animals.

ee also

* Spasmodic torticollis

References

External links

* [http://www.rabbit.org/journal/3-8/head-tilt.html Head Tilt: Causes and Treatment]


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Synonyms:

Look at other dictionaries:

  • Torticollis — Tor ti*col lis, n. [F. toricolis; L. torquere, tortum, to twist + collum the neck.] (Med.) See {Wryneck}. [1913 Webster] …   The Collaborative International Dictionary of English

  • Torticollis — (lat.), schiefer Hals …   Pierer's Universal-Lexikon

  • Torticollis — (lat.), Schiefhals (s. d.); T. spastica, rheumatica, Nickkrampf (s. d.) …   Meyers Großes Konversations-Lexikon

  • torticollis — 1811, Mod.L., from L. tortus crooked, twisted (see TORTUOUS (Cf. tortuous)) + collum neck (see COLLAR (Cf. collar)) …   Etymology dictionary

  • torticollis — [tôr΄ti käl′is] n. [ModL < L tortus, twisted + collum, the neck: see TORT & COLLAR] Med. a condition of persistent involuntary contraction of the neck muscles, causing the head to be twisted to an abnormal position …   English World dictionary

  • Torticollis — Klassifikation nach ICD 10 M43.6 Torticollis Q68.0 Angeborene Deformitäten des M. sternocleidomastoideus Torticollis congenitus (muscularis) …   Deutsch Wikipedia

  • Torticollis — The most common of the focal dystonias, torticollis is a state of excessive of inadequate muscle tone in the muscles in the neck that control the position of the head. It can cause the head to twist and turn to one side, and the head may also be… …   Medical dictionary

  • torticollis — /tawr ti kol is/, n. Pathol. a condition in which the neck is twisted and the head inclined to one side, caused by spasmodic contraction of the muscles of the neck. Also called wryneck. [1805 15; < NL, equiv. to L tort(us) twisted (see TORT) + i… …   Universalium

  • torticollis — noun Etymology: New Latin, from Latin tortus twisted + i + collum neck more at collar Date: circa 1811 a twisting of the neck to one side that results in abnormal carriage of the head and is usually caused by muscle spasms called also wryneck …   New Collegiate Dictionary

  • torticollis — noun A medical condition in which the neck muscles contract causing the neck to twist or jerk Syn: wryneck …   Wiktionary

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