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Condition/Disorder Synonyms

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  • Wry neck

  • Loxia

  • Congenital torticollis

  • Idiopathic torticollis

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ICD-9-CM Code

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  • 723.5 Torticollis unspecified

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ICD-10-CM Code

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  • M43.6 Torticollis

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Preferred Practice Pattern1

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Key Features

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Description

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  • Torticollis is a postural position of the neck with side-bending and opposite rotation

  • Contracted state of the cervical muscles

  • Cervical dystonia (CD) 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 cervical dystonia often present with combined postures associated with flexion, extension and side-bending.

  • Moving from side to side is called rotational spasmodic torticollis

  • Turning and shaking of the head is called mixed torticollis

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Essentials of Diagnosis

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  • Inherited: change in chromosomes

  • Acquired: damage to muscle or nerve

  • Idiopathic: unknown cause

  • Congenital: in fetal development, improper position of the fetus with changes in the blood supply or muscles of the neck

  • Age of onset

  • Distribution of symptoms

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General Considerations

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  • Can have an etiology or can be idiopathic

  • Treatment can include stretching, manual therapy, Botox injections or surgery

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Demographics

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  • Musculoskeletal condition during infancy is called congenital muscular torticollis

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Clinical Findings

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Signs and Symptoms

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  • Pain

  • Enlargement of the neck muscles

  • Limited ROM of neck

  • Headaches

  • Swelling of neck muscles at birth with congenital

  • Shoulder elevation on affected side

  • Ipsilateral head tilt and contralateral head rotation

  • Possible difficulty swallowing2

  • Marked limitation in ROM

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Functional Implications

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  • Postural control abnormalities

  • Greater reliance on vision for maintaining postural stability3

  • Reduced ability to perform ADLs involving head or neck movements

  • Difficulty sleeping

  • Reduced psychosocial functioning

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Possible Contributing Causes

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  • Idiopathic cause

  • Posture during sleeping

  • Posture of fetus in womb

  • Cold breeze on the neck

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Differential Diagnosis

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  • Diagnosis is by clinical examination; no standard laboratory tests are employed to diagnose.

  • Determining that there is no evidence of dystonia

  • In addition to the possible contributing causes listed above, the following pathologies must be ruled out to diagnose primary dystonia

    • Cervical disk disease

    • Spinal abnormalities

    • Epilepsy

    • Muscular dystrophy2

    • Thyroiditis

    • Endocrine disease4

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Means of Confirmation or Diagnosis

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Imaging

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  • X-ray

  • Electromyography (EMG)

  • Rule out congenital deformities of the cervical spine, ocular anomalies, CNS pathology,5 neoplasm, thyroiditis, endocrine disease3

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Diagnostic Procedures

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  • Diagnosis is made by clinical observation

  • Toronto western spasmodic torticollis rating ...

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