Overview of Torticollis
Torticollis is a musculoskeletal disorder characterized by contracture of the neck muscles. Generally, torticollis is recognizable by a position in which the head twists to one side, causing it in turn to tilt to the opposite side (the chin points to the side to which the head is rotated). The neck muscles involved in torticollis go beyond their normal range of motion; the movements involved in this condition are flexion, extension and rotation.
Another name for torticollis is “wry neck.”
Who Gets Torticollis?
Torticollis affects both children and adults. Children who are born with it (in this case it is called congenital torticollis) may have experienced an altered position of the head while in the womb. Injury to muscles and/or blood supply while in the womb is another cause of congenital torticollis.
Torticollis can be either genetic or acquired. Genetic torticollis develops slowly and involves your brain and nervous system. If you have this type of torticollis, it’s important to get it diagnosed and treated as soon as you notice symptoms. With the earliest possible treatment, you stand the best chance of reducing or eliminating the possibility of the condition's becoming permanent (i.e. living constantly with your neck in a twisted position).
Acquired torticollis generally arises from trauma or a reaction to drugs, and is considered to be an acute condition. (Acute torticollis is the lack of normal control of your neck muscles.)
Torticollis Causes and Risk Factors
As I mentioned above, trauma is both one possible cause and risk factor of torticollis, because trauma can result in muscle spasm, which may take your neck out of alignment.
Infection is another cause of torticollis: infections often affect your glands and lymph nodes (inflammatory torticollis), and when this happens, the result may be spasm in the muscles located directly above those structures.
Some drugs can result in the sudden involuntary contraction of neck, face and/or upper back muscles (acute torticollis). This can occur both from prescribed drugs such as Thorazine, as well as recreational drugs such as cocaine or amphetamines. Taking these types of drugs is considered a risk factor for torticollis.
Along with trauma and taking the types of drugs referenced above, a family history of torticollis and an abnormality of the neck at birth are also risk factors.
Common Torticollis Symptoms
So how can you tell if you have torticollis? Or at least if you should see your doctor?
Based on the fact that torticollis shows up as a position in which the head is turned to one side, this is the first thing to notice. Also, you’ll likely feel tenderness or pain in your neck and shoulder muscles.
And it may be painful or difficult, if not impossible, to try to move your head to the opposite side from which it feels “stuck.” Other things to take note of include headache, back pain, shoulder pain and burning sensations. If you have these symptoms, see your doctor.
Doctors generally diagnose torticollis by taking a medical history, doing a physical exam, and in the case of trauma-induced torticollis, by taking x-rays. Sometimes a CT scan is also needed.
Treatments for Torticollis
In general, torticollis is not life threatening. With that said, some symptoms indicate injury or irritation to the structures of your central nervous system (i.e. brain and/or spinal cord). If you have these symptoms, whether or not they are symptoms of torticollis, you should get to the emergency room, fast. The symptoms include:
- Difficulty breathing
- Difficulty swallowing
- Difficulty speaking
- Difficulty walking
- Weakness, numbness or pins and needles in your arms and legs
- Incontinence (urinary or fecal)
If you have neck-muscle spasms and a fever, swollen glands, neck stiffness, a headache and/or swelling, get medical attention immediately.
If you only have pain and stiffness in your neck, see your doctor as soon as you can, but you don’t need to go to the emergency room.
The goal of most torticollis treatments is to release the neck muscles from spasm or contracture. Typical treatments include medication, physical therapy, stretching, use of physical devices and surgery. Common medications given to people with torticollis include muscle relaxers and anti-inflammatories.
Many patients report that injections of botulinum toxin, i.e. Botox, helps their symptoms.
If you are treated for acute torticollis, you can most likely expect to get back to normal within a few days to a few weeks. If after this amount of time (and treatment) your pain and contractions do not abate, you may need a referral to a specialist — either a neurologist or a surgeon.
Surgery and Procedures for Spasmodic Torticollis and Cervical Dystonia
Surgery generally involves cutting the nerves responsible for transmitting the contraction impulses to the neck muscles, but it is rarely given. The downside of surgery is that often the twisted neck symptom returns a few months after the surgery.
Another procedure that is gaining steam in the treatment of torticollis is deep brain stimulation, often known as a treatment for Parkinson’s disease. When used for torticollis — in this case, for spasmodic torticollis, also known as cervical dystonia — it involves placing a device similar to a pacemaker (only for the brain) in the area at which it's believed the torticollis originates.
Cunha, John P. DO, FACOEP, Davis, Charles Patrick, MD, PhD. Torticollis. eMedicineHealth website. http://www.emedicinehealth.com/torticollis/article_em.htm#torticollis_overview
Dressler D. Botulinum toxin for treatment of dystonia. Eur J Neurol. 2010 Jul;17 Suppl 1:88-96. doi: 10.1111/j.1468-1331.2010.03058.x. http://www.ncbi.nlm.nih.gov/pubmed/20590814
Krauss JK. Surgical treatment of dystonia. Eur J Neurol. 2010 Jul;17 Suppl 1:97-101. doi: 10.1111/j.1468-1331.2010.03059.x.
Deep Brain Stimulation (DBS). National Spasmodic Torticollis Association web site. Accessed Feb 2013. http://www.torticollis.org/treament-deep-brain-stimulation.html
Torticollis. Medline Plus. National Institutes of Health (NIH). Last Updated May 21 2012. Accessed Feb 2013. http://www.nlm.nih.gov/medlineplus/ency/article/000749.htm
Wry neck/torticollis (& symptom). SNOMED Clinical Terms. BioPortal. Accessed Feb 2013. http://bioportal.bioontology.org/ontologies/46896?p=terms&conceptid=161883001