What is the torticollis and its management

the lateral curvature is usually accompanied by some rotational deformity. nature has defined four physiological curves in co-called erect spine

some also call torticollis as ‘wryneck’.”

common features of torticollis include

  • rotated face to the other side
  • macular changes
  • neck tilted to the same side
  • taut sternocleidomastoid
  • unilateral muscle paralysis

Some congenital disorders or any traumatic sprain can cause it.

spasmodic torticollis is the most common cause of wryneck.

Involuntary twisting or clonic movements of the neck characterize this, the most common form of focal dystonia

Emotional disturbance or attempts at correction sometimes trigger spasms.

Even at rest, the neck typically exhibits an abnormal posture, with the chin twisted to one side and upwards, and the shoulder on that side potentially elevated.

In some cases, the condition reveals as a more generalized form of dystonia when involuntary muscle contractions spread to other areas.

there are the cases associate with lesions of the basal ganglia, but the exact cause remains unknown.”

Some patients respond to local injections of botulinum toxin into the sternomastoid muscle

some acquired causes of torticollis is

  1. infective = tuberculosis of cervical spine, acute respiratory tract infection etc,
  2. ocular disturbance = child turns head to one side to compensate for defective vision
  3. myositis or fibromyositis of sternocleidomastoid = exposure to cold may cause myositis
  4. neuritis of spinal accessory nerve
  5. unilateral muscle paralysis due to polio

clinical features

the head of the patient is tilted towards the affected side

while, the chin of the individual points to the other side

sternocleidomastoid muscle is more prominently seen.

perhaps pain and immobility being the most common feature

In the later stages, the patient may develop facial asymmetry and macular disturbance in eyes

Management of torticollis

Initially, doctors manage it with conservative management.

this consists of non steroidal anti-inflammatory drugs (NSAID), muscle relaxants drugs, etc

suggesion of physiotherapy like ultrasound, heat therapy

in the acute condition the individual is asked to wear a collar and gradual neck exercises are advised

safter the failure of conservative management surgery is the step

it consists of release of sternomastoid muscle from its clavicular attachment

as in congenital torticollis and intradural section of both spinal accessory and three cervical roots in case of torticollis due to spasmodic or neural causes

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