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Torticollis

Last updated: March 17, 2021

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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.

  • Congenital (also referred to as infantile torticollis)
    • Age: 2–4 weeks
    • Sex: > (3:2) [1]
  • Acquired

Epidemiological data refers to the US, unless otherwise specified.

Overview of torticollis forms [3]

Type

Etiology

Clinical features

Management

Congenital torticollis

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.
  • See “Treatment” in “Dystonia.”

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:

  1. Amaral DM, Cadilha RPBS, Rocha JAGM, Silva AIG, Parada F. Congenital muscular torticollis: where are we today? A retrospective analysis at a tertiary hospital. Porto Biomedical Journal. 2019; 4 (3): p.e36. doi: 10.1097/j.pbj.0000000000000036 . | Open in Read by QxMD
  2. LeDoux MS. Dystonia: phenomenology.. Parkinsonism Relat Disord. 2012; 18 Suppl 1 : p.S162-4. doi: 10.1016/S1353-8020(11)70050-5 . | Open in Read by QxMD
  3. Karmel-Ross K. Torticollis: Differential Diagnosis, Assessment and Treatment, Surgical Management and Bracing . The Haworth Press, Inc ; 1997