• Clinical science

Torticollis (Wryneck)

Abstract

Torticollis is a clinical finding in which the neck twists to one side, with an associated asymmetric head or chin position. It is characterized by abnormal tone or length of the cervical muscles, which may be congenital or acquired, and can be the result of a variety of mechanisms (e.g., trauma, muscle tone disorders, congenital muscle tightness, extrinsic masses, ocular, etc.). Torticollis is predominantly a clinical diagnosis. Imaging may be required to determine the underlying etiology. Initial treatment consists of physical therapy (exercises for muscle lengthening and balance) and medication for dystonia (anticholinergics, benzodiazepines, baclofen). Surgical release is used for severe cases involving muscle shortening.

Epidemiology

  • Congenital (also referred to as infantile torticollis)
    • Age: 2–4 weeks
    • Sex: > (3:2)
  • Acquired
    • Wry neck/stiff neck : the most common type of torticollis in adults
    • Idiopathic cervical dystonia
      • Age of onset: 30–50 years
      • Sex: > (2:1)

References:[1][2]

Epidemiological data refers to the US, unless otherwise specified.

Types of torticollis

Type

Etiology

Clinical features

Management

Congenital torticollis

  • Physiotherapy: passive positioning
  • Surgery at 12 months of age if conservative management is insufficient

Acute torticollis (wry neck)

  • Trauma
  • Poor posture
  • Local exposure to cold
  • Spontaneous onset (usually, overnight and without provocation)
  • One or more painful neck muscles that limit the range of motion of the neck
  • Self-limiting (resolves spontaneously in 1–4 weeks)

Idiopathic Cervical Dystonia (spasmodic torticollis)

  • A definitive etiology is not yet clear.

Other forms of acquired torticollis

  • Similar to other forms of torticollis
  • Additionally, features of the underlying pathology (e.g., fever in cases with infection or neurological pain in cases with spondylosis with nerve compression)
  • Treatment of underlying causes:
    • Antibiotics for underlying infection
    • PPIs for reflux induced fibrosis
    • Withdrawal of the offending agent in the case of drug-induced reactions
    • IV diazepam or diphenhydramine is useful in drug-induced reactions
  • Extraocular muscle surgery (see treatment of ocular motility disorders)
  • Physiotherapy

References:[1][2][3][4][5][6][7][8]