TORTICOLLIS

General Information

DEFINITION--Shortened neck muscles or chronic neck-muscle spasm that causes the head to turn and bend.

BODY PARTS INVOLVED--Brain and central nervous system; muscular system.

SEX OR AGE MOST AFFECTED--Both sexes, but more common in adults age 30-60, or children under age 10. One form is congenital and affects newborns.

SIGNS & SYMPTOMS--

The following may be permanent or intermittent:

• Head that turns sideways and bends down.
• Neck-muscle spasm that is sometimes painful.

CAUSES

• Birth defect.
• Injury to neck muscles or vertebrae at birth or later.
• Neck-muscle inflammation.
• Cervical spine injury.
• Organic central nervous system disorder.
• Tumor.
• Stress and psychological conflict may cause intermittent torticollis.

RISK INCREASES WITH

• Tumors in soft tissues or bones of the neck.
• Traumatic delivery of newborn.
• Psychiatric illness.
• Trauma.
• Medications (phenothiazines, butyrophenones).
• Family history of torticollis.
• Hyperthyroidism.
• Brain diseases or infections.

HOW TO PREVENT--No specific prevention. Stress-related forms may be prevented with stress-reduction techniques, including biofeedback.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and physical exam by a doctor.
• Laboratory blood tests for infection and inflammation.
• X-rays of the spinal column in the neck. CT scan or MRI to help rule out other disorders (See Glossary for both).

APPROPRIATE HEALTH CARE

• Self-care after diagnosis.
• Doctor's treatment.
• Congenital torticollis is initially treated with physical therapy including daily passive therapy for at least a year. If therapy is not successful, then surgery to lengthen neck muscles is performed.
• For other forms of torticollis, various drug therapies are available that may help, along with physical therapy and massages.
• Neck brace or collar or ultrasound therapy may be recommended.
• Surgical procedure to denervate the neck muscles for some patients.

POSSIBLE COMPLICATIONS--Without treatment, the congenital form becomes permanent, causing an unattractive, abnormal appearance of the head and neck.

PROBABLE OUTCOME--

• Congenital torticollis can usually be corrected with muscle-stretching exercises or surgery.
• Other forms will improve or heal with treatment. Healing time varies. Some cases require treatment for several years.

How To Treat

GENERAL MEASURES--

• Relieve pain from neck spasms with heat or massage. Take hot showers or use hot compresses, deep-heating ointments or heat lamps.
• Follow your doctor's instructions regarding massage or physical therapy. Compliance with your medical treatment plan is essential for the best outcome.

MEDICATION--Your doctor may prescribe:

• Anticholinergics, benzodiazepines, muscle relaxants, or tricyclic antidepressants (drug possibilities to help reduce the symptoms).
• Multiple injections of botulinum toxin type A into the neck muscles..

ACTIVITY--Normal actvities may be resumed as soon as symptoms improve.

DIET--No special diet.

Call Your Doctor If

• Your infant has symptoms of torticollis.
• You have neck pain or spasms that persist longer than 1 week.