Torticollis

Causes

Torticollis may be:

• Inherited -- due to changes in your genes
• Acquired -- develops as a result of damage to the nervous system, upper spine, or muscles

If the condition occurs without a known cause, it is called idiopathic torticollis.

Torticollis may develop in childhood or adulthood. Congenital torticollis (present at birth) may occur if the baby's head was in the wrong position while growing in the womb, or if the muscles or blood supply to the neck are injured.

Symptoms

• Limited range of motion of the head
• Headache
• Head tremor
• Neck pain
• Shoulder that is higher on one side of the body
• Stiffness of the neck muscles
• Swelling of the neck muscles (possibly present at birth)

Exams and Tests

Tests or procedures may be done to rule out possible causes of head and neck pain. A physical examination will show:

• Head tilts toward the affected side while the chin points to the opposite side
• Shortening of the neck muscles
• The entire head pulls and turns to one side (in more severe cases)

Tests that may be done include:

• CT scan of the neck
• Electromyogram (EMG) to see which muscles are most affected
• MRI of the brain

Treatment

Treating torticollis that is present at birth involves stretching the shortened neck muscle. Passive stretching and positioning are used in infants and small children. These treatments are often successful, especially if they are started within 3 months of birth.

Surgery to correct the neck muscle may be done in the preschool years, if other treatment methods fail.

Torticollis that is caused by damage to the nervous system, spine, or muscles is treated by identifying the cause of the disorder.

• Applying heat, traction to the cervical spine, and massage may help relieve head and neck pain.
• Stretching exercises and neck braces may help with muscle spasms.
• Medications may be used, including the anticholinergic drug baclofen.
• Injecting botulinum toxin can temporarily relieve torticollis, but repeat injections are usually needed every 3 months.
• Surgery of the spine might be needed when the torticollis is due to dislocated vertebrae. In some cases, surgery involves destroying some of the nerves in the neck muscles, or brain stimulation.

Outlook (Prognosis)

The condition may be easier to treat in infants and children. If torticollis becomes chronic, numbness and tingling may develop due to pressure on the nerve roots in the neck.

The muscle itself may become large (hypertrophic) due to constant stimulation and exercise.

Possible Complications

Complications may include:

• Muscle swelling due to constant tension
• Nervous system symptoms due to pressure on nerve roots

When to Contact a Medical Professional

Call for an appointment with your health care provider if symptoms do not improve with treatment, or if new symptoms develop.

Torticollis that occurs after an injury or with illness may be serious. Seek immediate medical help if this occurs.

Prevention

While there is no known way to prevent this condition, early treatment may prevent it from getting worse.

Alternative Names

Wry neck; Loxia

References

Spiegel DA, Hosalkar HS, Dormans JP, Drommond DS. The neck. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap. 679.

Persing J. Prevention and management of positional skull deformities in infants. American Academy of Pediatrics Committee on Practice and Ambulatory Medicine, Section on Plastic Surgery and Section on Neurological Surgery. Pediatrics. 2003;112:199-202.

Patel M, Shah K. Orthopedics. In: Rakel RE, ed. Textbook of Family Medicine. 7th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 42.

Update Date: 5/21/2012

Updated by: Luc Jasmin, MD, PhD, Department of Neurosurgery at Cedars-Sinai Medical Center, Los Angeles, and Department of Anatomy at UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.