Torticollis

(Spasmodic Torticollis; Cervical Dystonia)

Definition

Torticollis is a problem where the head turns and tilts to one side and the chin points to the other side. One shoulder may lift. It may be all the time or may come and go.

Causes    TOP

The causes aren’t clear. It may be from:

  • Infant's body pose before birth or during birth
  • Head or neck injury
  • Problems with genes
  • Infection in neck muscles or bones
  • Problems with the nervous system
  • Ear or eye problems
  • Misshapen bones or muscles in the neck
  • Tumors of the head or neck
  • Arthritis of the neck
  • Use of certain medicines

Risk Factors    TOP

This problem is more common in females, kids under 10, and adults who are 30-60 years old. You are at risk if someone in your family has this condition.

Symptoms    TOP

Muscles of the Neck

Neck Muscles
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Symptoms are:

  • Rotation and tilting of the head to one side
  • Stiff neck
  • Painful spasms of neck and upper back
  • Poor range of the head and neck
  • Headache

Symptoms range from mild to severe. It often worsens slowly for 1-5 years. Then it slows and stays the same. It may last for life. It can result in problems moving and affect your posture.

Diagnosis    TOP

You will be asked about your symptoms and health history. A physical exam will be done.

Pictures may be needed. This can be done with:

Treatment    TOP

Treatment depends on whether the problem has been since birth (congenital) or started later (acquired). Physical therapy, oral medicine, botulinum toxin (Botox) injections, and surgery may be done. Other methods are:

Congenital Torticollis

  • Stretching several times a day
  • Surgery to make the tendon longer

Acquired Torticollis

  • Physical therapy and Botox to help relax the muscle and reduce pain
  • Surgery to cut the nerve to the muscle that is in spasm
  • Deep brain stimulation
  • Certain oral medicines for pain or to relax the muscles
  • Injections of:
    • Botox to weaken or partly paralyze the muscle—This may help with neck posture. It is best if it is done soon after torticollis starts. It wears off after a few months. It must be done again.
    • Alcohol or phenol to deaden the nerve that causes the muscle to contract

Prevention    TOP

It can’t be prevented. Early medical care may keep things from getting worse.

RESOURCES:

Dystonia Medical Research Foundation
http://www.dystonia-foundation.org
National Spasmodic Torticollis Association
http://www.torticollis.org

CANADIAN RESOURCES:

The College of Family Physicians of Canada
http://www.cfpc.ca

References:

Cervical dystonia. Dystonia Medical Research Foundation website. Available at: https://www.dystonia-foundation.org/what-is-dystonia/forms-of-dystonia/focal-dystonias/cervical-dystonia. Accessed June 4, 2018.
Cervical dystonia. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T132176/Cervical-dystonia. Updated April 13, 2017. Accessed June 4, 2018.
Collins A, Jankovic J. Botulinum toxin injection for congenital muscular torticollis presenting in children and adults. Neurology. 2006;67:1083-1085.
Corrado G, Fossati C, et al. Irritable oesophagus: A new cause of Sandifer's syndrome. Acta Paediatr. 2006;95:1509-1510.
Dystonias fact sheet. National Institute of Neurological Disorders and Stroke website. Available at: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Dystonias-Fact-Sheet. Updated December 7, 2017. Accessed June 4, 2018.
Herman MJ. Torticollis in infants and children: common and unusual causes. Instr Course Lect. 2006;55:647-653.
Hoehn KS, Capouya JD, et al. Lemierre-like syndrome caused by community-associated methicillin-resistant Staphylococcus aureus complicated by hemorrhagic pericarditis. Pediatr Crit Care Med. 2010;11(3):e32-5.
Marion MH, Humberstone M, Grunewald R, Wimalaratna S. British Neurotoxin Network recommendations for managing cervical dystonia in patients with a poor response to Botulinum toxin. Pract Neurol. 2016;0:1-8. Available at:
...(Click grey area to select URL)
Accessed June 4, 2018.
Preto TE, Dalvi A, et al. A prospective blinded evaluation of deep brain stimulation for the treatment of secondary dystonia and primary torticollis syndromes. J Neurosurg. 2008;109:405-409.
Last reviewed June 2018 by EBSCO Medical Review Board Warren A. Bodine, DO, CAQSM
Last Updated: 6/16/2015

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