Torticollis (wry neck)

Torticollis, also known as “wry neck”, is abnormal and tilting downward of the head and neck due to a problem in the muscles of the neck. Torticollis is derived from two Latin words which are tortus meaning twisted, and collum which generally means the neck.

What happens in most Torticollis cases is the abnormal twisting of the head to one side, while the chin tilts to the other side and the neck is twisted so as to point the head downwards.

The most common form of Torticollis is called Congenital Muscular Torticollis and is present in babies during birth. However, in the case that a person acquires long after childhood, the condition is now known as Acquired Torticollis and can be a sign of an underlying, more serious medical condition.

What factors can Cause Torticollis?

To understand Torticollis, it is important to understand the anatomy behind it. The neck has two long muscles, one on each side, that is located from your collarbone to the back of your ear. These muscles are labeled as sternocleidomastoid, or SCM for short, and will contract when the neck is flexed.

Torticollis occurs when this muscle is shorter on one side. In the case of babies, this muscle can become shortened when the baby has been in an abnormal position for a long period of time, for example, a breech position. Or the baby might have been cramped in the womb right before it was delivered. When this happens, the SCM on one side of the baby’s neck can tighten and shorten in the process.

As for adults developing “wry neck”, the cause may be a previous nervous system or neck muscle injury. But most of the time, medical specialists have no knowledge of what causes most Torticollis cases in adults. This type of Torticollis or “wry neck” can also be referred to as Idiopathic Torticollis.

Types of Torticollis

Torticollis comes in many forms, and most types of Torticollis are classified on what the source or cause of the problem is. These are some of the known types of Torticollis around:

• Temporary Torticollis: this is one of the most common types of Torticollis in adults, and once they appear, only lasts for a few hours and up to two days. The cause of this type of Torticollis is mostly unknown, but there are certain conditions that can induce “wry neck” in a person. These conditions are an injury to your neck or head that can cause swelling and cause the SCM to tighten, having swollen lymph nodes, having an ear infection, and sometimes by having something as simple as a cold.
• Fixed Torticollis: This is the complete opposite of temporary Torticollis as it can last permanently if not treated. This type of “wry neck” may be due to a problem with the muscles or bones in your neck and head.
• Muscular Torticollis: This is also one of the more common types of Torticollis, and can be caused by scare tissue or tightening of muscles on side of the neck or SCM.
• Klippel- Feil Syndrome: although this is a rare form of Torticollis, it can happen to babies when their necks formed incorrectly in a womb.

Risk Factors Commonly Associated with Torticollis

Although there is no concrete indication as to what might cause Torticollis among the many different causes, especially in adults, there are still risk factors that can increase your likelihood of experiencing Torticollis. Some of these risk factors include:

• Family history of the disorder may increase your risk of developing Torticollis yourself.
• Congenital abnormalities in the cervical spine or abnormalities present at birth
• Previous trauma or injury to the neck and spine can cause the muscles in these parts of your body to involuntarily contract and have spasms.
• Injuries to the cervical spine leading to muscle spasms that may cause twisting of the head
• Infections in the head and neck
• Inflamed and infected lymph nodes in the neck
• Infections and abscesses in the throat
• Infections of the mastoids, ears, and jaw
• Use of drugs both legal and illegal that induce involuntary muscle control such as cocaine, ketamine, chlorpromazine, prochlorperazine, and haloperidol.

Complications as a Result of Torticollis

There are certain complications that may develop as a result of Torticollis, such as:

• Neck deformity: prolonged Torticollis, if not treated can lead to permanent neck deformity
• Constant neck stiffness and pain: if not treated immediately, Torticollis can leave lasting neck stiffness and pain.
• Muscle swelling in the neck
• Neurological symptoms: certain neurological may develop if the Torticollis is not treated

Torticollis Symptoms and Diagnostic Procedures

What are some of the most common Torticollis Symptoms?

Torticollis symptoms generally happen gradually and slowly at first and are noticed when the patient attempts to keep their head straight and finds difficulty in doing so. Torticollis symptoms may gradually worsen over time. Some of the most common Torticollis symptoms include:

1. 1. Head is Tilted to One Side: Torticollis is defined as the tilting of your head to one side and the stiffness of your neck, so it is given that this is one of the most common Torticollis symptoms. However, what you may not know is that there are four different ways of describing Torticollis, and they are classified according to where your head is tilted towards.
      • Laterocollis is when the head is tipped towards your shoulder
      • Retrocollis is when your head is pulled to the back
      • Rotational Torticollis is when the head turns to one side or the other
      • And lastly, Anterocollis is what happens when your head is pulled forward

It is possible that a combination of two or more of these Torticollis symptoms can be observed in a single occurrence of the condition.

1. Having One Shoulder Higher: along with the tilting of your head, there is a visible difference in shoulder height as there is a tightening of the muscles in the neck and sometimes in your shoulders that may cause one part of your shoulder to appear higher than the other
2. Being Unable to move your Neck and Head: The most common Torticollis symptoms and one that easily signifies you have the condition is the inability move your head and neck, and a general stiffness in the side of your neck, due to the tightening of the SCM or the sternocleidomastoid.
3. Swollen neck: The swelling of the muscles in your neck due to tightening is a clear sign that you possibly have Torticollis, especially in the sides of your neck as this is where the SCMs are located.
4. Headache: Sometimes, there will be a headache present in either the onset of Torticollis or after the condition has persisted for a few hours. A headache is caused by the obvious discomfort of having your head tilted to one side for a long time, but sometimes can also be indicative of a muscle starting to tighten and cause pain to your head and the immediate area around it.

Congenital Muscular Torticollis Symptoms

The Torticollis symptoms in babies, on the other hand, are usually more or less the same as those in adults, although they are harder to notice and keep track off as the baby isn’t able to communicate well what he/she is feeling. Some of the Torticollis symptoms in babies are listed below:

• Tilting of Head to One Side: If your baby has been tilting their head to one side for an extended period of time, then it may be a possible Torticollis symptom. This is especially evident if your baby is tilting their head to the right side, as 75% of Torticollis cases in babies tilt their head to the right.
• Inability to Move Head and Neck Easily: much like in Torticollis that happens in adults, one of the most common Torticollis symptoms is the inability to move the head to one side, or to move it up, down, left and right easily.
• A Soft Lump in your Baby’s Neck: If you feel that your baby has the two Torticollis symptoms mentioned above, then your baby might have congenital muscular Torticollis, and it is now imperative that you examine your child for a soft lump on the side of their neck. Contact your physician for further examinations.
• Trouble Breastfeeding: You will have trouble breastfeeding your baby as he/she will be unable to flexibly tilt his head to one side, and can only be breastfed on one side of his body. When your baby does this, then he/she may have Torticollis. These are symptoms to definitely make your physician aware of so that an accurate diagnosis can be established.
• Flat Head on One side: Your baby may develop a condition called Positional Plagiocephaly, or getting a flat portion on one side of the baby’s head. This condition is caused by the baby lying in one position most of the time perhaps due to Torticollis, and since the baby’s bones are not yet fully formed and strong, any prolonged pressure on one of his head can result in its flattening.

Diagnostic procedures

Your physician will need to know your medical history, including the medications you take. You will also be given a physical exam to try to determine the cause of your Torticollis. If you have a history of injury or trauma, your physician may order X-rays to make sure you don’t have a dislocation or fracture of the vertebrae in your neck. If X-rays are unable to provide the physician with enough information, or if there is evidence of degenerative arthritis or other abnormalities, the doctor may recommend a CT scan.

Other tests may include:

• Laboratory tests: Tests like blood or urine studies can help determine if there is infection present that may be causing the Torticollis.
• Magnetic Resonance Imaging (MRI): This imaging study to help identify other problems that may be causing your symptoms.
• Electromyography (EMG): This test helps evaluate the functioning of the nerves and muscles. It can help diagnose Cervical Dystonia (Torticollis) or rule out other causes of your symptoms.

Torticollis Exercises, Treatment, and Aftercare

What are the Recommended Forms of Torticollis Exercises and Treatments?

Fortunately, wry neck, especially in the case of temporary Torticollis will go away after a few hours or a few days. How these types of Torticollis are treated and made to go away are as mysterious as how they are caused in the first place. However, some cases of Torticollis may persist after a few or more days, and if not treated can cause long-lasting damage to the muscles in your neck and head. Even temporary Torticollis leaves a dull pain in the muscles of your neck after it has gone away. So it is safe to say that it is important to treat Torticollis, and here are the few treatments you can use to treat the condition:

Torticollis Exercises and Physical Therapy

Torticollis exercises such as stretching the neck muscles are what doctors would primarily prescribe the patient, such as in the case of the common “wry neck.” This remedy is also backed up by recent researches that suggest Torticollis exercises and physical therapy are ideal options to treat the condition in a noninvasive and virtually cost-free way. This study on Torticollis exercises and physical therapy is especially true in infants who have congenital muscular torticollis or CMT, which suggest that Torticollis exercises performed by a parent or a guardian are as effective as those performed in clinics.

Some Torticollis exercises and physical therapy you can do in your own home are:

• One of the best Torticollis exercises is stretching the affected neck muscles in a prone position both actively and passively
• Another good Torticollis exercises you can do is stretching the neck muscles with the support of a pillow. This is done by placing the side affected by Torticollis against the pillow in order to keep the neck away from the affected side whenever you sleep
• Control of your posture with the use of U-shaped neck pillows, ergonomic car seats or the use of rolled blankets. All of these methods aim to keep the neck in a neutral position and can be a form of passive Torticollis exercise
• Torticollis exercises involving the rotation of the neck in sitting and supine positions. In the case of infants, you can easily have them do this task by attracting their attention and diverting them into rotating their head with a combination of one or more of these: toys, lights, and sounds
• In the case of infants, placing them in the crib affected-side down and making them face the wall so that they have to rotate their head to the non-affected side to face against of the wall is also an effective Torticollis exercise
• Constant interaction with the infant so that his neck is constantly stimulated and stretched properly to treat his/her Torticollis

These Torticollis exercises treatments are ideally done as early as possible upon being affected with the condition so as to have a full recovery and decrease you or your baby’s chances of ever having the condition again.

Surgery for Torticollis

Torticollis exercise won’t necessarily work when it comes to severe cases of Torticollis, and in these cases, your doctor may suggest that you undergo surgery to fix the problem in the Sternocleidomastoid muscles of your neck. However, there is little to worry about surgical Torticollis treatments nowadays as they are done Laparoscopically (meaning they are done using small incisions around the area) and in a minimally invasive way.

Surgery can be done both for adults and babies, but in the case of babies, only when they are over 12 months old. Even then, they are assessed by the doctor to determine their overall surgical risk, if they are safe to be operated upon. Surgical procedures can be done in a number of ways, and largely depends on what the cause of your “wry neck” is. Some of these surgical procedures are as follows:

• Separation of Sternocleidomastoid muscles in your neck
• Lengthening these neck muscles
• Fusing abnormal vertebrae near your neck.

Torticollis Treatment Aftercare

Some of the aftercare you can do even after doing Torticollis exercise or surgery you can do comfortably at home, and are essential to ensure you won’t experience the condition anymore. Some of these home aftercare methods include:

• Applying heat to the affected area to stimulate the muscles
• Massaging the neck muscles
• Neck braces to keep support on your neck and lessen the pressure your neck muscles endure.

Medications

Many times, a combination of medications must be used to relieve the symptoms of Cervical Dystonia. These can include:

• Botulinum Toxin: This is the same drug that is sometimes used to reduce facial wrinkles and creases due to aging. It is injected into the muscles of the neck that are affected by Torticollis. Most of the time, this is a very effective treatment for Cervical Dystonia, but it needs to be repeated every few months.
• Parkinson’s drugs: Drugs which are used to help the symptoms of Parkinson’s disease are often used with injections of botulinum toxin to help decrease muscular contraction of torticollis. Side effects of these medications may include constipation, dry mouth, reduced stream of urine, memory problems and blurring of the vision.
• Muscle relaxants: Muscle relaxants are used to relax the muscles of the neck and relieve the pain of torticollis, but they can cause imbalance, sedation and impaired cognition.
• Pain medications: Depending on the amount of pain caused by Torticollis, pain medications may range from those that are available over-the-counter to those that are available only with a doctor’s prescription.