Torcicollis
Medically reviewed by Joseph Palermo, D.O.; American Osteopathic Board Certified Internal Medicine
REFERENCES:
"Congenital Torticollis." WebMD.com. July 21, 2011. <http://www.webmd.com/parenting/baby/tc/congenital-torticollis-topic-overview>.
Herman, M.J. "Torticollis in Infants and Children: Common and Unusual Causes." Instr Course Lect. 55 (2006): 647-653. <http://www.ncbi.nlm.nih.gov/pubmed/16958498>.
Kruer, Michael C. "Torticollis." Medscape.com. Mar. 6, 2012. <http://emedicine.medscape.com/article/1152543-overview#aw2aab6b2b3aa>.
Medically Reviewed by a Doctor on 12/9/2014
Torcicollis
Torticollis (wryneck) is one of a broader category of disorders that exhibit flexion, extension, or twisting of muscles of the neck beyond their normal position. In torticollis, the neck tends to twist to one side, causing head tilt. The condition can either develop slowly if you have a family history of the disorder, or acutely from trauma, or as an adverse reaction to medications.
When the disorder occurs in people with a family history, it is referred to as spasmodic torticollis. The characteristic twisting of the neck is initially spasmodic and begins between 31-50 years of age. If you leave the condition untreated, it likely will become permanent.
Bending or twisting your neck too far can lead to acute torticollis. This condition appears with few symptoms, although often you will appear uncomfortable and will hold your head straight or rotated to one side. It will hurt to move your head to the opposite side. Your neck muscles on the side that hurts often are tender to the touch. The doctor will check your nerve and motor function to rule out spinal cord injury.
Torticollis Causes and Risk Factors
In adults, acute torticollis can be caused by many different conditions. Occasionally, no condition is found as a cause.
Trauma to the neck or spine can lead to torticollis. Injuries to the cervical spine or neck muscles often result in spasm of the muscles, leading to the twisting of the head, characteristic of torticollis.
Other causes include infection of the head or neck. These infections can cause an inflammatory torticollis secondary to inflamed glands and lymph nodes in the neck. The muscles overlying these lymph nodes contract. Torticollis may be associated with abscesses of the throat and upper airway, and those situations can be life-threatening. Other infections of the sinuses, ears, mastoids, jaw, teeth, or scalp can lead to torticollis.
Rarely, tumors, scar tissue, arthritis of the cervical spine, or vascular abnormalities may also cause torticollis.
Certain drugs of abuse such as ketamine, amphetamines, and cocaine as well as commonly prescribed neuroleptic drugs such as prochlorperazine(Compazine), haloperidol (Haldol), and chlorpromazine (Thorazine) can cause acute dystonia (a lack of normal muscle control). This is a condition that involves the sudden onset of involuntary contractions of the muscles of the face, neck, or back.
In addition to bending of the head to one side (acute torticollis), you may experience deviation of the eyes (oculogyric crisis) and protrusion of the tongue (buccolingual crisis). In addition to the causes above, children, infants, and newborns may also acquire torticollis from congenital causes or trauma due to childbirth. Congenital muscular torticollis is the most common cause of torticollis in infants.
Risk factors for torticollis include a family history of the disorder, congenital abnormalities of the cervical spine, taking drugs that predispose to muscular spasm, and trauma.
Torticollis Symptoms and Signs
- Because spasmodic torticollis is an abnormal contraction of the muscle in one side of the neck, people will appear with their head turned to one side. Neck muscles and those between the neck and shoulder will be tense and tender.
- People with acute torticollis will be unwilling to turn their head to one side or may have their head turned slightly away from the side of discomfort.
- Other symptoms may include shoulder pain, back pain, headache, neck cramps, muscle tightness, or burning sensations.
When to Seek Medical Care
In general, acute torticollis is not life threatening. If symptoms are limited to muscle stiffness and pain, see your doctor in at least a day.
If you injure your neck and have spasm of the muscles, go immediately to a hospital's emergency department. Other medical conditions may appear to be torticollis and will need immediate medical attention. Anyone who experiences spasms of the neck muscles involved with swallowing or breathing or symptoms that might involve the central nervous system should be evaluated.
The following symptoms suggest injury or irritation to the central nervous system and should be treated as an emergency especially if they suddenly develop:
- Trouble breathing or swallowing
- Pins-and-needles feeling or numbness in your arms and legs
- Urinary hesitancy, urinary or fecal incontinence
- Weakness in your arms and legs
- Impaired speech
- Difficulty walking
- If the spasm of the neck muscles is associated with fever, swollen glands, headache, neck stiffness, mouth or tongue swelling, or trouble swallowing, seek medical attention immediately.
Torticollis Diagnosis
The doctor will take a detailed history emphasizing specific medications that you may be taking. A physical examination will be performed.
When there is a history of trauma, the doctor may take X-rays of your neck to exclude a fracture or dislocation of the spinal bones in your neck.
- Often, X-rays are sufficient to make this determination.
- In a small number of cases, subtle abnormalities or preexisting conditions, for example, degenerative arthritis of the spine or of the neck may require aCT scan.
Torticollis Treatment
Treatment for torticollis is targeted to relax the contracted neck muscles involved. Treatments include medication, physical devices, botulinum toxin, physical therapy, stretching exercises, and surgery. In most people, torticollis resolves in several days to a few weeks. A few people will develop continuing neck problems for months to years. Persistent neck muscle spasms may require referral to a neurologist or surgeon
Torticollis Medications
- If you have spasmodic torticollis that was caused by trauma or by medications, the doctor may prescribe muscle relaxants and anti-inflammatory drugs. These agents usually relieve the symptoms completely within a few days. Common medications to treat acute, spasmodic torticollis includebenztropine (Cogentin) ordiphenhydramine (Benadryl). These medications are usually given into the muscle or through the vein. The doctor may add muscle relaxant or benzodiazepines such as Ativan or Valium. The medications are continued in their oral form for 48-72 hours to avoid recurrent symptoms. Ice packs and massage therapy may also be used for relief.
- For chronic neck muscle spasms, a neurologist may give a local injection of botulinum A toxin (Botox). This toxin comes from Clostridium botulinum bacteria. It acts locally to prevent muscle contraction in the muscles where it is injected. The toxin often can stop torticollis from progressing and can lead to complete recovery. Continue Reading
Torticollis Surgery
Surgery is reserved only for a few selective cases. In this treatment, some of the upper neck nerves are selectively severed to prevent muscle contraction. Surgical treatment often helps, but frequently the neck will return to its twisting position after several months. Continue Reading
Torticollis Prognosis
- The prognosis for torticollis is generally good. Most people with acute torticollis are successfully treated with medication. If a drug caused the spasm, it should be stopped. Spasmodic torticollis is successfully treated with local injections of botulinum A toxin in combination with medications. If these conservative measures are unsuccessful, surgery on the nerves of the neck can be attempted. After surgery, many people will often have initial relief, but most relapse after several months.
- For the great majority of people with acute torticollis, the condition goes away in several days to a few weeks. A small number of people will go on to develop continuing problems with their neck for months to years.
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