Torticollis (Wry Neck)

Infant with Congenital Muscular Torticollis
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Definition

Torticollis literally means “wry neck”. It comes from the term tortus meaning twisted and collum denoting to neck. Infants born with this deformity has a twisted neck (congenital torticollis) has a head tipped to one side while the chin is rotated to one side.

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Types

Torticollis is classified into:

  • Congenital Muscular Torticollis– present at birth and the most common form.
  • Acquired Torticollis – acquired later in life
Incidence
  • 1 in every 250 neonates is born with congenital torticollis.
  • Ten to twenty percent of infants with torticollis have also a congenital hip dysplasia (improper formation and function of the hip socket.)
Risk Factors

Fetuses with wide shoulders are at high risk of injuring the sternocleidomastoid muscle during delivery due to the pressure exerted on the head to deliver the shoulder.

Causes

Congenital Torticollis causes

  • Injury of sternocleidomastoid muscle during birth
  • Injured blood supply of the fetus’ neck at birth
  • Wrong position of fetus while inside the womb resulting to tightness of the sternocleidomastod muscle (muscle that connects the breastbone and the collarbone to the skull)
  • Klippel-Fiel Syndrome  (less common cause)

This is characterized by abnormalities in the bones of the neck (cervical vertebrae) where the bone is abnormally formed and/or fused.

  • Inherited (rare cases only)
  • Result of underlying condition that damages the nervous system or muscles (e.g. spinal or brain tumor)

Acquired Torticollis causes

  • Damage of the nervous system
  • Damage of the muscles around the neck
  • Tumors of the skull base (posterior fossa tumor)
  • Pharyngitis (can irritate the nerves supplying the neck muscles and cause a wry neck)
  • Use of antipsychotics (acute dystonia)
Assessment
  • Positional plagiocephaly (asymmetrical head shape)
  • X-ray
  • Electromyogram (EMG)
Clinical Manifestations

Congenital Torticollis

  • Painless
  • Head posture abnormality:

If the right sternocleidomastoid is injured: the infant’s head is rotated to the right and chin rotated to the left.

If the left sternoceidomastoid muscle is affected: the infant’s head is rotated to the left and chin turned to the right.

  • Lump in the affected muscle (can be palpated or noticeable at about 1-2 months of age)
  • Limited range of motion of the head
  • Swelling of the neck muscles (possibly present at birth)
  • Shoulder is higher on one side of the body
  • Stiff neck muscles

Acquired Torticollis

  • Painful neck
  • Shoulder is higher on one side of the bosy
  • Stiff neck muscles
  • Head posture abnormality
  • Head tremor
  • Headache
  • Shoulder is higher on one side of the body
Management

Congenital Torticollis

  • Passive stretching exercises and encouraging the infant to look at the affected muscle (by feeding at the direction of the affected area and positioning mobiles on the injured part).
  • If simple exercises are not effective, a surgical correction is done. This is followed by usage of neck immobilizer to further correct the deformity.

Acquired Torticollis

  • Identification of underlying cause of the disorder.
  • Heat application for head and neck pain
  • Cervical spine traction
  • Neck massage
  • Anticholihergic drugs
  • Use of Botulism (Botox)