Torticollis
Other Names
- Torticollis
- Wryneck
- Cervical Dystonia
Background
- This page refers to Torticollis, a condition characterized by abnormal, sustained tilting and rotation of the head and neck
History
- Needs to be updated
Epidemiology
- Incidence of CMT ranges from 0.3% to 16% of newborns.[1]
- Third most common congenital musculoskeletal condition in newborns.
Introduction
- Torticollis is characterized by abnormal, sustained tilting and rotation of the head and neck, most commonly due to unilateral shortening or contracture of the sternocleidomastoid (SCM) muscle.
- Can be classified as either congenital or acquired, with congenital muscular torticollis (CMT) being the most common form in infants and young children.
- CMT typically presents at or shortly after birth and is thought to result from perinatal factors such as intrauterine malposition, birth trauma, or vascular compromise to the SCM, leading to fibrosis and muscle shortening.
- Acquired torticollis can occur at any age and has a broad differential, including trauma, infection, osseous abnormalities, ocular disorders, and dystonic reactions.
Pathophysiology
- Pathophysiology depends on the underlying etiology
- In CMT, perinatal muscle injury, intrauterine malposition, or vascular compromise results in muscle fibrosis and contracture, causing unilateral shortening or fibrosis of the SCM
- In acquired torticollis, the pathophysiology varies and may involve musculoskeletal, neurological, infectious, or ocular causes.
- Musculoskeletal causes include trauma, neck sprain/strain, and vertebral anomalies leading to abnormal cervical alignment.
- Neurological causes include drug-induced acute dystonic reactions (eg, drug-induced), posterior fossa lesions, and cerebral palsy.
- Infectious etiologies, such as upper respiratory tract infection, retropharyngeal abscess, and cervical vertebral osteomyelitis.
- Ocular torticollis arises from compensatory head tilt to maintain binocularity in patients with conditions such as strabismus, nystagmus, and cranial nerve palsy.
Risk Factors
Differential Diagnosis
Differential Diagnosis Neck Pain
- Fractures
- Subluxations and Dislocations
- Neuropathic
- Muscle and Tendon
- Pediatric/ Congenital
- Other Etiologies
Clinical Features
History
- Needs to be updated
Physical Exam
- Needs to be updated
Special Tests
- Needs to be updated
Evaluation
- Diagnostic studies are not typically required unless red flag signs
- CMT
- Ultrasound cervical spine: initial evaluation, helps assess fibrosis or other structural causes
- X-ray cervical spine or CT neck: to assess bony abnormalities
- MRI brain/neck: for CNS causes, suspected in patients with neurologic deficits
- Acquired Torticollis
- Musculoskeletal: X-ray cervical spine, CT neck
- Neurological: MRI brain/neck, CT neck
- Infectious: CBC with differential, cultures, inflammatory markers
Classification
Management
Nonoperative
- CMT
- Acquired
Operative
- CMT
- Acquired
Rehab and Return to Play
Rehabilitation
Return to Play/ Work
Prognosis and Complications
Prognosis
Complications
See Also
References
- ↑ Heidenreich E, Johnson R, Sargent B. Informing the update to the physical therapy management of congenital muscular torticollis: evidence-based clinical practice guideline. Pediatr Phys Ther. 2018;30(3):164–175. doi:10.1097/PEP.0000000000000517.