Contents
Definition
- Torticollis is a common term for various conditions of head and neck dystonia which displays specific variations in head movement
- Torticollis results in a fixed or dynamic posturing of the head and neck in tilt, rotation, and flexion
- Spasms of the sternocleidomastoideus, trapezius and other neck muscles, usually more prominent on one side than the other, cause a turning or tipping of the head.
Occurrence
- Common between 15-30 years of age
- Very rare before age of 12 years of age
Causes
- Can result from 12
- Injury
- Inflammation of cervical muscles or cranial nerves from different disease process
- Head/neck trauma
- Sleeping in an awkward position
- Post-traumatic (10-20% of cases) – 3 to 12 months after injury – more related to cervical dystonia
Development
- Patient wakes in the morning experiencing a stiff neck
- Trying to move the head when getting up is difficult and painful
- Pain is experienced in neck, trapezius and scapula area
- More rarely it may develop acutely as a result of specific movements, injury to head or by coughing
- Moving the neck aggravates the condition
- The patient finds comfort in lying down, which improves the painful situation
- If trying to change position while lying down, the patient will often ‘hold the head’ and help in moving the head by using their hands
Indications
- Marked stiffness with severe problems voluntarily making specific neck movements which gives pain when attempted
Observation
- Clear asymmetrical position of the head
- Usually in lateral flexion of the neck or rotation
- Head may be deviated towards or away from painful side
Examination
- Neck rotation – painful and severely limited
- May be in one direction or both
- Neck lateral flexion – painful and severely limited
- May be in one direction or both
- Neck resisted movements of the neck are often painful and weak
- Shoulder movements can also be limited