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Torticollis

In torticollis, a neck deformity also known as wryneck, spastic or shortened sternocleidomastoid neck muscles cause the head to tilt to the affected side and the chin to rotate to the opposite side. The disorder may be congenital or acquired. Congenital (muscular) torticollis mostly affects infants after difficult delivery (breech presentation), firstborn infants, and girls. Acquired torticollis usually develops either before age 10 or after age 40. It may be acute, spasmodic, or hysterical.

Causes

  • Genetic defect
  • Infant's position during pregnancy or delivery
  • Head or neck injury
  • Damage or malfunction of the nervous system, specifically the basal ganglia, which is a deep brain structure
  • Inner ear or eye problems
  • Deformities of the bones or muscles in the neck
  • Tumors of the head or neck
  • Arthritis of the neck
  • Gastroesophageal reflux in infants (passage of acid from the stomach into the throat)
  • Use of certain medications, including:
    • Phenothiazines
    • Butyrophenones

Signs and Symptoms

Symptoms may include:

  • Rotation and tilting of the head to the affected side
  • Enlargement of neck muscles, possibly present at birth.
  • Stiffness of neck muscles
  • Painful spasms of neck and upper back muscles
  • Limited range of motion of the head and neck
  • Headache

Torticollis ranges from mild to severe. It usually progresses slowly for 1-5 years, and then plateaus. However, torticollis may persist for life and can result in limited movement and deformed posture.

Diagnostic tests

X-rays of the cervical spine don't reveal bone or joint disease but may be used to detect an associated disorder.

Treatment

In congenital torticollis, the goal of treatment is to stretch the shortened neck muscle. Nonsurgical treatment for an infant includes passive neck stretching proper positioning during sleep. For an older child, treatment involves active stretching exercises. Surgical correction should be done during preschool years and only if other therapies fail.

Treatment for acquired torticollis is done to correct the underlying condition. In the acute form, application of heat, cervical traction, and gentle massage may relieve pain. Stretching exercises and a neck brace may relieve symptoms of the spasmodic and hysterical forms.

In elderly patients with acquired torticollis, treatment may include carbidopa-levodopa, carbamazepine, and haloperidol.

Prevention:

While there is no known prevention, early treatment may prevent a worsening of the condition.



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