Jan Patrick D.
Peñaflorida
BSN 4-M
Torticollis, or wry neck, is a condition in which the head is tilted toward one side (cervical
Lateral flexion), and the chin is elevated and turned toward the opposite side (cervical
extension).
Congenital muscular torticollis
The etiology of congenital muscular torticollis is unclear. Birth trauma or intrauterine
malposition is also considered to cause damage to the sternocleidomastoid muscle in the neck.
[citation needed]
This results in a shortening or excessive contraction of the sternocleidomastoid
muscle, often with limited range of motion in both rotation and lateral bending. The head is
typically tilted in lateral bending toward the affected muscle and rotated toward the opposite
side.
The reported incidence of congenital torticollis is 0.3-2.0 %.[1] Sometimes a mass (a
sternomastiod tumor) in the affected muscle may be noted, this appears at the age of two to four
weeks, it disappears gradually, but sometimes the muscle becomes fibrotic. It is likely to
disappear within the first five to eight months of life.
The condition is treated initially with physical therapy, with stretching to correct the tightness,
strengthening exercises to achieve muscular balance, handling to stimulate symmetry. A TOT
Collar is sometimes used. About 5–10% require "surgical release" of the muscle if stretching
fails.[2][3]
Infants with torticollis have a higher risk for plagiocephaly. Altering the head position and using
a pillow when supine helps as does giving a lot of tummy time when awake.
Other less common causes such as tumors, infections, ophthalmologic problems and other
abnormalities should be ruled out. For example, ocular torticollis due to cranial nerve IV palsy
should not be treated with physical therapy. In this situation, the torticollis is a neurologic
adaptation designed to maintain binocularity. Treatment should be targeted at the extraocular
muscle imbalance.
In general, if torticollis is not corrected facial asymmetry can develop.[citation needed] Head position
should be corrected before adulthood (to about the age of 18 there can be improvement).
Younger children show the best results.
Congenital torticollis develops in the infant but can be diagnosed at older ages, even in adults
who were missed as infants/children.
The word torticollis means wry neck: Acquired torticollis is not the same as congenital
torticollis. All ages can suffer from acquired torticollis.
Common treatments[citation needed] might involve a multi-phase process:
1) Low-impact exercise to increase strong form neck stability
2) Manipulation of the neck by a chiropractor, physical therapist, or D.O.†
3) Extended heat application.
4) Repetitive shiatsu massage.
†An Osteopathic Physician (D.O.) may choose to use Cranial techniques to properly position the
occipital condyles - thereby relieving compression of cranial nerve XI in children with
Torticollis. This is an example of Osteopathic Manipulative Treatment.
Acquired torticollis
Acquired torticollis occurs because of another problem and usually presents in previously normal
children and adults.
Trauma to the neck can cause atlantoaxial rotatory subluxation, in which the two
vertebrae closest to the skull slide with respect to each other, tearing stabilizing
ligaments; this condition is treated with traction to reduce the subluxation, followed by
bracing or casting until the ligamentous injury heals.
Tumors of the skull base (posterior fossa tumors) can compress the nerve supply to the
neck and cause torticollis, and these problems must be treated surgically.
Infections in the posterior pharynx can irritate the nerves supplying the neck muscles and
cause torticollis, and these infections may be treated with antibiotics if they are not too
severe, but could require surgical debridement in intractable cases.
Ear infections and surgical removal of the adenoids can cause an entity known as Grisel's
syndrome, a subluxation of the upper cervical joints, mostly the atlantoaxial joint, due to
inflammatory laxity of the ligaments caused by an infection. This bridge must either be
broken through manipulation of the neck, or surgically resected.
The use of certain drugs, such as antipsychotics, can cause torticollis.[4]
Antiemetics - Neuroleptic Class - Phenothiazines
There are many other rare causes of torticollis.
How is it treated?
To treat congenital torticollis, you'll learn to stretch your baby's tight neck muscle several times a
day. Your doctor or a physical therapist will teach you how to safely do the exercises.
Another way to help you stretch your baby’s neck is to do things so that he or she rotates the chin
toward the shoulder of the affected side. For example:
During feeding, hold your child in a way that makes him or her rotate the chin to the
correct position.
Place the crib so that your child turns his or her chin the correct way in order to see the
room.
Place toys and other objects in such a way that your baby has to turn his or her head to
see them and play with them.
If your baby does not improve after a few months of stretching, contact your doctor. There may
be another problem, or surgery may be needed to stretch or lengthen the neck muscle.
The lump in the muscle usually goes away on its own.
If the congenital torticollis is not caused by a shortened neck muscle but by a cervical spine
abnormality, the spine abnormality is sometimes treatable.
