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  • Wry neck
  • Loxia
  • Congenital torticollis
  • Idiopathic torticollis

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  • 723.5 Torticollis unspecified

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  • M43.6 Torticollis

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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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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

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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 scale
  • Torticollis rating scale of Tsui
  • Cervical dystonia impact profile

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Medication

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  • Botulinum toxin A
    • Two preparations are available: Botox and Dysport.
    • Injected into overactive musculature to weaken dystonic muscles
    • Injections often performed with electromyography (EMG) to enhance accuracy
    • Average duration ...

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