TORTICOLLIS

(Wryneck; Cervical Dystonia)

 Basic information

description

Torticollis is a problem of the neck muscles that causes a twisted head movement. Torticollis is a type of movement disorder (dystonia). It usually affects adults ages 30 to 60 (women more than men). Congenital torticollis is a type that affects newborns.

FREQUENT SIGNS & SYMPTOMS

• Symptoms may begin slowly and progress over time or develop suddenly.
• Head turns (or tilts) toward one shoulder while the chin turns toward the opposite shoulder. The head may be pulled forward or backward.
• The head may not move from the abnormal position (tonic), may have jerky head movements (clonic), or may have both types.
• Neck muscles are tense and tender.
• There may be pain in the neck, back, or shoulder.
• In a newborn, a lump may be felt in the neck muscle.

causes

• The nerves and muscles involved are affected by various causes. Sometimes, no cause is found. This is called idiopathic spasmodic torticollis.
• In the congenital type, the exact cause is unknown.

risk increases with

• Family history of torticollis.
• Cervical spine problems (injury, fractures, scar tissue, tumor, infections, ligament problems, and others).
• Inflammatory problems (such as myositis and others).
• Certain prescribed drugs.
• Some drugs of abuse.
• Infection in tissues around neck muscles.
• Congenital type risks include position of the baby in the womb, a difficult delivery, or certain birth defects.

PREVENTIVE MEASURES

No specific preventive measures.

expected outcomes

• The symptoms often improve with one or more types of treatment. Complete remission may occur. Other patients may have neck problems for months or years.
• Congenital torticollis can usually be corrected with muscle-stretching exercises or surgery, if needed.

possible complications

• Condition becomes chronic; depression; disability.
• Social phobia.

 diagnosis & treatment

general measures

• Your health care provider will do a physical exam of the affected area and ask questions about your symptoms and activities. Medical tests may include x-rays, MRI, CT, and studies of muscle movements.
• Congenital torticollis is initially treated with physical therapy, including daily passive therapy for at least a year. If therapy is not successful, then surgery to lengthen neck muscles is performed.
• For other forms of torticollis, drug therapies may help, along with physical therapy, and other therapies.
• If a drug is causing the problem, it should be stopped.
• A neck brace or collar may be recommended.
• Relieve pain from neck spasms with heat or massage. Take hot showers or use warm, moist compresses, deep-heating ointments, or heating pad.
• "Sensory tricks" may help. Place a hand on the chin, side of face, or back of neck to reduce muscle spasms.
• Stress may worsen symptoms. Learn stress-reduction techniques, including biofeedback.
• Electrical stimulation may be recommended.
• Rarely, a surgical procedure to denervate (cut the nerves) in the neck muscles may be recommended.
• To learn more: National Spasmodic Torticollis Association, 9920 Talbot Ave., Suite 233, Fountain Valley, CA 92708; (800) 487-8385; website: www.torticollis.org.

medications

• Muscle relaxants, anti-inflammatories, or other drugs may be prescribed. They may be taken by mouth or injected by your health care provider.
• Injections of botulinum toxin into the neck muscles may be prescribed.

activity

Activity limits will be determined by your symptoms.

diet

No special diet.

 notify our office if

• You or a family member has symptoms of torticollis.
• You have neck pain or spasms that last over 1 week.

Special Notes: