Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ Wry neckLoxiaCongenital torticollisIdiopathic 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 rotationContracted state of the cervical musclesCervical 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 torticollisTurning and shaking of the head is called mixed torticollis +++ Essentials of Diagnosis ++ Inherited: change in chromosomesAcquired: damage to muscle or nerveIdiopathic: unknown causeCongenital: in fetal development, improper position of the fetus with changes in the blood supply or muscles of the neckAge of onsetDistribution of symptoms +++ General Considerations ++ Can have an etiology or can be idiopathicTreatment can include stretching, manual therapy, Botox injections or surgery +++ Demographics ++ Musculoskeletal condition during infancy is called congenital muscular torticollis +++ Signs and Symptoms ++ PainEnlargement of the neck musclesLimited ROM of neckHeadachesSwelling of neck muscles at birth with congenitalShoulder elevation on affected sideIpsilateral head tilt and contralateral head rotationPossible difficulty swallowing2Marked limitation in ROM +++ Functional Implications ++ Postural control abnormalitiesGreater reliance on vision for maintaining postural stability3Reduced ability to perform ADLs involving head or neck movementsDifficulty sleepingReduced psychosocial functioning +++ Possible Contributing Causes ++ Idiopathic causePosture during sleepingPosture of fetus in wombCold 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 dystoniaIn addition to the possible contributing causes listed above, the following pathologies must be ruled out to diagnose primary dystoniaCervical disk diseaseSpinal abnormalitiesEpilepsyMuscular dystrophy2ThyroiditisEndocrine disease4 +++ Imaging ++ X-rayElectromyography (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 observationToronto western spasmodic torticollis rating scale Torticollis rating scale of Tsui Cervical dystonia impact profile +++ Medication ++ Botulinum toxin ATwo preparations are available: Botox and Dysport.Injected into overactive musculature to weaken dystonic muscles... Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free a profile for additional features.