Definition

Torticollis is when 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

The exact cause is not known. It may be from:

  • An 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

This problem is more common in women, children under 10, and adults who are 30 to 60 years old. The risk is higher in people who have other family members with this problem.

Symptoms

Muscles of the Neck
Neck Muscles

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

Problems may be:

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

Diagnosis

The doctor will ask about your symptoms and health history. A physical exam will be done.

Pictures may be needed. This can be done with:

Treatment

Treatment depends on whether the problem has been since birth (congenital) or started later (acquired). Options 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 ease 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

There are no known ways to prevent this problem.

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

Health Canada
https://www.canada.ca

REFERENCES:

Cervical dystonia. Dystonia Medical Research Foundation website. Available at: https://dystonia-foundation.org/what-is-dystonia/types-dystonia/cervical-dystonia. Accessed October 9, 2020.

Cervical dystonia. EBSCO DynaMed website. Available at:https://www.dynamed.com/condition/cervical-dystonia. Accessed October 9, 2020.

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. Accessed October 9, 2020.

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: http://pn.bmj.com/content/early/2016/03/14/practneurol-2015-001335.full.pdf+html. Accessed October 9, 2020.

Tomczak KK, Rosman NP. Torticollis. J Child Neurol. 2013 Mar;28(3):365-378.

Last reviewed September 2020 by EBSCO Medical Review Board Laura Lei-Rivera, PT, DPT, GCS  Last Updated: 10/9/2020