Torticollis (Wryneck) in Children and Adults

Torticollis (wryneck) occurs when the neck turns or twists into an involuntary position. It affects both children and adults. There are two main types: congenital (present at birth, often in first pregnancies) and acquired due to causes like infection or spinal changes.

Congenital torticollis in infants is generally painless, while acquired torticollis often causes neck pain and restricted neck movements. Torticollis is typically not a medical emergency, though it can be.

This article discusses torticollis symptoms, possible causes, and diagnosis. It explains how torticollis treatment (including physical therapy) can offer benefits.

What Is the Cause of Torticollis?

The potential causes of torticollis depend on the type.

Congenital Torticollis

Congenital torticollis occurs due to the shortening of one of the sternocleidomastoid muscles (SCMs). The SCMs are two large muscles in the neck that connect the back of your skull to your breastbone (sternum) and clavicle (on either side)

After hip dysplasia (often seen with torticollis) and equinovarus foot disorders, it is the third-most common congenital condition in newborns and infants. The exact cause is unknown but may be due to:

• Crowding within the uterus during pregnancy
• Fibrosis of the muscle from bleeding and/or trauma during childbirth
• Primary myopathy (muscle disease) of the SCM
• Abnormal development of this muscle

Acquired Torticollis

Torticollis can develop as a consequence of a chronically strained neck position or damage to the muscles that move the neck. Possible causes include:

• Scar tissue
• Muscle spasm (including cervical dystonia)
• Inflammation or infection

Injury to the sternocleidomastoid or the trapezius (a muscle involved in shoulder and neck movements) can lead to acquired torticollis. Rarely, there are other culprits behind torticollis, like a tumor or bleeding in the cervical spine.

Torticollis Symptoms

Like the underlying causes, the symptoms of torticollis vary based on the type.

Congenital Torticollis

Congenital torticollis is a painless condition that causes babies to have their head tilted to one side and rotated to the opposite side. If the baby's left ear is closer to their left shoulder, then their face will be turned more towards the right side.

The tilt and the rotation are not always in opposite directions, however. Sometimes, with congenital torticollis, the baby favors rotation to the same side of the tilt.

In addition to a head and chin tilt, babies with congenital torticollis may have a lump on the side of the neck that the head is tilted toward. Babies with congenital torticollis may also have an asymmetrical appearance of the face.

Acquired Torticollis

Children and adults with acquired torticollis usually experience neck pain with certain neck movements, as well as a "locked" sensation after quickly rotating their neck. Headaches, head tremors, and stiff or swollen neck muscles can accompany these symptoms. One shoulder may also appear higher than the other.

Other symptoms of torticollis in children and adults often correlate with the underlying cause.

• If an infection is the cause of the torticollis, a fever may be present.
• With benign paroxysmal torticollis (a type of acquired torticollis in children), episodes of head tilting are associated with symptoms like vomiting, paleness, irritability, ataxia, or sleepiness.
• With ocular torticollis (also a type of acquired torticollis that's more common in children), a child may tilt their head to the side to avoid a visual disturbance, like double vision.
• Finally, torticollis that occurs as a reaction to a medication may be accompanied by tight jaw muscles and problems speaking.

Torticollis Diagnosis

The diagnosis of torticollis begins with a thorough medical history.

Your healthcare provider may ask you questions about when your symptoms started and whether you have associated symptoms, such as pain, fever, headache, or neurological problems. and whether there was an inciting injury or trauma. They will also ask about your medication exposures.

Your healthcare provider will then do a physical exam that is focused on your head and neck muscles and nervous system.

Sometimes imaging tests—like an X-ray, computed tomography (CT) scan, or magnetic resonance imaging (MRI)—may be warranted, especially if there is a history of trauma.

Is Torticollis Curable?

The treatment of congenital torticollis usually involves physical therapy to help stretch and straighten out the neck. Surgery to lengthen or release the muscle may be needed.

To relieve neck pain and help relax the neck muscles, the following therapies may be recommended:

• Medications like nonsteroidal anti-inflammatories (NSAIDs) and muscle relaxants
• Physical therapy and home stretching exercises
• Cervical collar

Botulinum toxin (Botox) injections can also be helpful, especially for spasmodic torticollis.

The treatment of acquired torticollis is focused on treating the underlying cause (such as antibiotics for an infection) and easing symptoms.

Summary

Torticollis is a neck condition that can affect both children and adults. Its causes are not fully known, but it can be a congenital condition diagnosed at birth or an acquired condition caused by external factors, like chronic muscle strains, infection, or medication.

Torticollis can be treated effectively, especially with an early diagnosis. Physical therapy can be a key component of your treatment plan. It's possible that torticollis can become severe, or be a part of an underlying health condition that requires treatment.

Due to the complexity of this condition and the fact that treatment is often warranted, if you think that your child (or yourself) might have torticollis, be sure to talk to your healthcare provider.