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Condition/Disorder Synonyms

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  • Focal dystonia

  • Dystonia

  • Spasmodic torticollis

  • Anterocollis

  • Retrocollois

  • Laterocollis

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ICD-9-CM Code

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  • 333.83 Spasmodic torticollis

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ICD-10-CM Code

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  • G24.3 Spasmodic torticollis

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Preferred Practice Pattern

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Key Features

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Description

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  • Dystonia is a condition that is characterized by involuntary intermittent or prolonged muscular contractions, such as twisting or repetitive movements, which may cause abnormal postures and movements

  • Dystonia may be generalized or focal

  • Cervical dystonia (CD) is the most common focal dystonia

  • Cervical dystonia is commonly referred to as spasmodic torticollis, which may be misleading

    • Spasmodic describes movements that are intermittent or clonic and tremulous, though some patients with CD present with prolonged contractions

    • Torticollis implies rotary impairment, though patients with CD often present with combined postures associated with flexion, extension, and side-bending

  • Further classification may be based upon head position or movement2

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Essentials of Diagnosis

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  • Traditional classification is based upon etiology

    • Primary (idiopathic)

    • Secondary (of known cause)

  • Current classification describes each person based upon the following characteristics

    • Age of onset

    • Distribution of symptoms

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General Considerations

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Demographics

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Clinical Findings

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Signs and Symptoms

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  • Common to patients with primary and secondary CD

    • Pain

    • Enlargement of the neck muscles

    • Shoulder elevation on affected side

    • Ipsilateral head tilt and contralateral head rotation

    • Head tremor or spasmotic jerking

    • Tremors of the arm

    • Possible difficulty swallowing

  • Unique to patients with post-traumatic CD

    • Marked limitation in range of motion

    • Lack of improvement after sleep

    • Lack of Geste antagoniste, also known as sensory tricks, are physical positioning, such as touching the chin, which have been shown to temporarily reduce dystonia5

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Functional Implications

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  • Postural control abnormalities

  • Greater reliance on vision for maintaining postural stability1

  • Reduced ability to perform activities of daily living involving head or neck movements

  • Difficulty sleeping

  • Reduced psychosocial functioning

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Possible Contributing Causes

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