Torticollis (patient information)

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Editor-in-Chief: C. Michael Gibson, M.S.,M.D. [mailto:mgibson@perfuse.org] Phone:617-632-7753; Associate Editor-In-Chief: Varun Kumar, M.B.B.S.

Synonyms and Keywords: Wry neck; Loxia

Overview
Torticollis is a twisted neck in which the head is tipped to one side, while the chin is turned to the other.

What are the symptoms of Torticollis?

 * Limited range of motion of the head
 * Headache
 * Head tremor
 * Neck pain
 * Shoulder is higher on one side of the body
 * Stiffness of neck muscles
 * Swelling of the neck muscles (possibly present at birth)

What causes Torticollis?

 * Torticollis may be:
 * Inherited: Due to specific changes in your genes
 * Acquired: Develops as a result of damage to the nervous system 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 fetus' head is in the wrong position while growing in the womb, or if the muscles or blood supply to the fetus' neck are injured.

When to seek urgent medical care?

 * 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 immediate medical help if this occurs.

Diagnosis
Various tests or procedures may be done to rule out possible causes of head and neck pain.


 * A physical examination will show a visible shortening of the neck muscles and the head will tilt toward the affected side while the chin points to the opposite side. In more severe cases, the entire head pulls and turns to one side


 * A electromyogram (EMG) may be done in mild cases to see which muscles are most affected.

Treatment options

 * Treatment of congenital torticollis involves stretching the shortened neck muscle. Passive stretching and positioning are treatments used in infants and small children. Such treatments are often successful, especially if started within 3 months of birth.


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


 * Acquired torticollis is treated by identifying the underlying cause of the disorder. Application of heat, traction to the cervical spine, and massage may help relieve head and neck pain. Stretching exercises and neck braces may help with muscle spasms.


 * Medications used to treat this condition include an anticholinergic drug called baclofen. Injection of botulinum toxin can temporarily relieve the torticollis, but repeat injections every 3 months are usually needed. Surgery is rarely used.

Where to find medical care for Torticollis?
Directions to Hospitals Treating Torticollis

What to expect (Outlook/Prognosis)?

 * The condition may be easier to correct in infants and children. If the condition becomes chronic, numbness and tingling may develop as nerve roots become compressed in the neck.


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


 * Botulinum toxin injections often provide substantial relief.

Possible complications
Complications may include:
 * Muscle swelling due to constant tension
 * Neurological symptoms due to compressed nerve roots

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

Source
http://www.nlm.nih.gov/medlineplus/ency/article/000749.htm