Alternative Names spasmodic torticollis, congenital torticollis, wry neck
Definition Torticollis is a deformity of the neck in which the muscles are spastic or shortened. Torticollis occurs in 1 out of 10,000 people. It is more common in women than men.
What is going on in the body? Torticollis develops most often between the ages of 30 and 60. However, it can occur at any age. The deformity causes a person's head to bend toward the affected side. The chin is rotated towards the opposite side.
What are the signs and symptoms of the condition? The first sign of torticollis is usually stiffness of the neck muscle on one side. A sensation of pulling towards the affected side follows. This is accompanied by twitching or contraction of the muscles. The person may experience severe neck pain and head pain. Usually the individual has limited range of motion in the neck. An infant born with this condition may have limited neck movement. The shoulder on the affected side is usually elevated. There may be an enlargement of the neck muscle.
What are the causes and risks of the condition? In some cases torticollis is congenital, meaning that the person is born with the condition. The condition can also be acquired. This form falls into 3 categories:
acute. This is the result of muscle damage caused by inflammation diseases, such as tuberculosis. It can also be brought on by cervical spinal injuries that produce scar tissue.
spasmodic. This is a result of muscle spasms cause by a central nervous disorder.
hysterical. This is due to the inability to control neck muscles that has a basis in psychological causes.
What can be done to prevent the condition? There is no known prevention for this condition.
How is the condition diagnosed? A physical examination will show a shortening of the neck muscles and the head tilting toward the affected side. X-rays of the neck may show an associated disorder such as tuberculosis, scar tissue, or arthritis.
What are the long-term effects of the condition? If the condition becomes chronic, numbness and tingling sensations in the arm and hand may develop. This is caused by the nerve roots becoming compressed in the cervical spine.
What are the risks to others? There are no risks to others.
What are the treatments for the condition? The goal of treatment is to stretch the shortened neck muscle. If an individual is born with the condition, intensive physiotherapy is started within the first few months of life. If physiotherapy is unsuccessful, the muscle may have to be repaired surgically. The pain caused by the acquired form of the condition may be eased by the application of heat, and gentle massage. Stretching exercises and a neck brace may help to relieve symptoms of the spasmodic and hysterical forms. Medication such as anticholinergeric medications, which block specific nerve impulses, or mild sedatives may be used. Muscle relaxants and antidepressants are occasionally prescribed. Surgically removing the nerves to the affected neck muscle is sometimes successful. This may be tried if other treatments fail. If emotional problems contribute to the spasms, psychotherapy may help.
What are the side effects of the treatments? There are possible side effects with any surgery. These include bleeding, infection, and allergic reactions to the medications used to control pain. All medications have possible side effects. Specific side effects depend on the medications used.
What happens after treatment for the condition? Torticollis varies from mild to severe. Some people get full relief after treatment. However, the condition may persist for life. It may produce continued pain, restricted movement of the neck, and postural deformities.
How is the condition monitored? The person can monitor symptoms and contact the doctor as needed.
Author: Gail Hendrickson, RN, BS Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
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