Torticollis

• Wry neck
• Loxia
• Congenital torticollis
• Idiopathic torticollis

• 723.5 Torticollis unspecified

• M43.6 Torticollis

• 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM Associated with Localized Inflammation

Description

• 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

Essentials of Diagnosis

• 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

General Considerations

• Can have an etiology or can be idiopathic
• Treatment can include stretching, manual therapy, Botox injections or surgery

Demographics

• Musculoskeletal condition during infancy is called congenital muscular torticollis

Signs and Symptoms

• 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

Functional Implications

• 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

Possible Contributing Causes

• Idiopathic cause
• Posture during sleeping
• Posture of fetus in womb
• Cold breeze on the neck

Differential Diagnosis

• 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

Imaging

• X-ray
• Electromyography (EMG)
• Rule out congenital deformities of the cervical spine, ocular anomalies, CNS pathology,5 neoplasm, thyroiditis, endocrine disease3

Diagnostic Procedures

• Diagnosis is made by clinical observation
• Toronto western spasmodic torticollis rating scale
• Torticollis rating scale of Tsui
• Cervical dystonia impact profile

Medication

• Botulinum toxin A
  • Two preparations are available: Botox and Dysport.
  • Injected into overactive musculature to weaken dystonic muscles
  ...