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Torticollis(Spasmodic Torticollis; Cervical Dystonia)
Definition

Torticollis affects the ability to control neck muscles from contracting. This causes the head to turn and tilt to one side, and the chin to point to the opposite side. Sometimes one shoulder is lifted. The muscle contraction may be constant or may come and go.

Causes

The causes of torticollis are not well understood. Causes may include:

  • Genetic defect
  • Infant's position during pregnancy or delivery
  • Head or neck injury
  • Infection in neck muscles or bones
  • Damage or failure of the nervous system
  • Inner ear or eye problems
  • Deformities of the bones or muscles in the neck
  • Tumors of the head or neck
  • Arthritis of the neck
  • Use of certain medications
Risk Factors

Factors that may increase your chance of developing this condition include:

  • Sex: female
  • Age: Children under age 10
  • Age: Adults aged 30-60 years
  • Family member with torticollis or similar disorders
Symptoms

Muscles of the Neck

Neck Muscles

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Symptoms may include:

  • Rotation and tilting of the head to one side
  • Shortening of neck muscles on one side, possibly present at birth
  • Stiffness of neck muscles
  • Painful spasms of neck and upper back muscles
  • Limited range of motion of the head and neck
  • Headache

Torticollis ranges from mild to severe. It usually progresses slowly for 1-5 years, and then stays the same. However, torticollis may last for life and can result in limited movement and deformed posture.

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done.

Your doctor may need pictures of structures inside your body. This can be done with:

Treatment

The treatment for torticollis depends on whether it is congenital or acquired. Treatment generally centers on physical therapy, oral medication, botulinum toxin injections, and surgery. Possible treatments may include:

Congenital Torticollis
  • Stretching exercises several times each day
  • In some situations, surgery to lengthen the tendon
Acquired Torticollis
  • Identifying the cause
  • Physical therapy, especially when used with botulinum toxin, to help relax the muscle and reduce pain
  • In some situations, surgery to cut the nerve to the muscle that is in spasm
  • Deep brain stimulation surgery
  • Certain oral medications, such as pain medication and muscle relaxants
  • Injections
    • Injection of botulinum toxin to weaken or partially paralyze the muscle—This may help improve neck posture, but only if begun soon after torticollis begins. The drug's effect wears off after several months and treatment must be repeated.
    • Injection of alcohol or phenol to deaden the nerve that causes the muscle contraction
Prevention

There are no guidelines to prevent torticollis. Early treatment may help keep the symptoms from worsening.

RESOURCES:

Dystonia Medical Research Foundation
http://www.dystonia-foundation.org

National Spasmodic Torticollis Association
http://www.torticollis.org

CANADIAN RESOURCES:

The College of Family Physicians of Canada
http://www.cfpc.ca

Health Canada
http://www.hc-sc.gc.ca

References:

Cervical dystonia. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 29, 2012. Accessed October 8, 2013.

Cervical dystonia (spasmodic torticollis). Dystonia Medical Research Foundation website. Available at: http://www.dystonia-foundation.org/pages/cervical_dystonia_more_info/46.php. Accessed October 8, 2013.

Collins A, Jankovic J. Botulinum toxin injection for congenital muscular torticollis presenting in children and adults. Neurology. 2006;67:1083-1085.

Corrado G, Fossati C, et al. Irritable oesophagus: A new cause of Sandifer's syndrome. Acta Paediatr. 2006;95:1509-1510.

Dystonias fact sheet. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/dystonias/detail_dystonias.htm. Updated July 2, 2013. Accessed October 8, 2013.

Herman MJ. Torticollis in infants and children: common and unusual causes. Instr Course Lect. 2006;55:647-653.

Hoehn KS, Capouya JD, et al. Lemierre-like syndrome caused by community-associated methicillin-resistant Staphylococcus aureus complicated by hemorrhagic pericarditis. Pediatr Crit Care Med. 2010;11(3):e32-5.

Preto TE, Dalvi A, et al. A prospective blinded evaluation of deep brain stimulation for the treatment of secondary dystonia and primary torticollis syndromes. J Neurosurg. 2008;109:405-409.



Last reviewed October 2013 by Michael Woods, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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