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Torticollis

Disease Overview

Torticollis, also called wryneck or twisted neck, is a condition caused by tightened or shortened neck muscles. Children with this condition often have poor head control and tilt their head towards one side with the chin turned to the other side. This is usually observed in the first 6 to 8 weeks of life. In newborns, it can occur as a result of abnormal positioning of the head in the womb. In older children, it may result from injury to the neck muscles or from infections.

Causes

Torticollis may be an inherited defect, an acquired condition or congenital.

  • Inheritance: Gene mutations may result in different types of birth defects which may cause torticollis in the newborn.
  • Acquired causes of torticollis in children are:
    • Injury to the neck muscles caused by sleeping in an abnormal position (sleeping on the stomach or with head turned to one side)
    • Dislocation/fracture of the vertebrae in the neck.
    • Infection or inflammation of lymph nodes in the neck may interfere with neck movement. Retropharyngeal abscess, an infection causing abscess deep in the throat, is common in children 2-4 years of age.
    • Injury or diseases of the nervous system.
  • Congenital torticollis is present at birth and is usually caused by abnormal positioning of the growing fetus’s head in the womb which results in injury to the neck muscles.

Signs and Symptoms

Children with torticollis may exhibit various signs and symptoms such as:

  • Painless swelling or mass in the neck (can appear in infants during the first month).
  • Tilting of the head to one side with the chin pointing to the shoulder on the opposite side.
  • Limited ability to move the neck or turn the head.
  • One side of the face and head looks flattened (plagiocephaly) from the child laying their head on the same side while sleeping.
  • Pain and stiffness in the neck are characteristic symptoms of torticollis caused by injury or infection.

Diagnosis

Your orthopedic physician will diagnose torticollis based on the birth history which reveals the possibility of any birth injury and a careful physical examination. X-rays and ultrasound examination of the neck may be done to rule out other abnormalities and confirm the diagnosis. A thorough neurologic exam helps to assess the cause of the disease.

Treatment

Treatment for torticollis depends on the cause and is generally a conservative approach of physical therapy exercises and medicine. In rare cases, if muscle stiffness persists and limits head movement in children after the age of 1 year, surgery may be considered.

Conservative Treatment

  • Medical Therapy: Medications prescribed for the treatment of acquired torticollis include analgesics such as NSAID’s (nonsteroidal anti-inflammatory drugs) and anticholinergic drugs. Botulinum toxin type A injection may be injected into the neck muscles to improve range of motion. Most cases of acquired torticollis are self-limiting and resolve within 2 weeks.
  • Physical Therapy: The goal of physical therapy is to stretch the shortened neck muscles. Physical therapists will perform passive stretching exercises of the head and neck, massage, and apply heat to the area to accomplish this goal, Physical therapy is helpful in the treatment of congenital torticollis before the age of 1 year and resolves the condition in 90% of cases.
  • Surgical Correction: Surgery to correct torticollis may be recommended in children who develop facial asymmetry or if conservative treatment is unsuccessful. Surgery is performed in a hospital operating room under general anesthesia. Your surgeon makes a 3 – 4 cm long incision on the skin over the affected sternocleidomastoid muscle of the neck. The muscle is dissected free from its attachment to the bone. The incision is sutured and a surgical dressing is placed. Surgery may also be performed using minimally invasive technique called endoscopic tenotomy of sternocleidomastoid muscle. Surgical repair usually resolves the condition and recurrence is rare. After surgery PT will be ordered for range of motion exercises and follow-up with your surgeon is recommended until complete resolution of the condition where the child will be able to rotate the head and neck in all directions.

Risks and Complications

Complications are rare but can include the following:

  • Injury to nerves
  • Bleeding
  • Infection
  • Numbness
  • Neck deformity
  • Loss of muscle control