2- Torticollis (Kusienski) Flashcards
A 50 yo man on vacation in Miami presents to your office with what looks like “wry neck”, with a palpable SCM muscle and his ipsilateral shoulder elevated. What dysfunction do you think he has?
Torticollis!
Tortus = twisted Collum = neck
A 50 yo man on vacation in Miami presents to your office with what looks like “wry neck”, with a palpable SCM muscle and his ipsilateral shoulder elevated. You automatically realize it is Torticollis. Which muscle do you remember is usually contracted in torticollis?
scalenus muscle group (and muscles of the posterior spine)
Which of the following falls under traumatic torticollis?
a) with osseous injury (or without osseous injury)
b) Spasmodic or Tumor related
c) Hysterical
d) Congenital
a) with osseous injury (or without osseous injury)
b) Spasmodic or Tumor related = Neurological
c) Hysterical = It’s own category of torticollis
d) Congenital = Age
What is the #1 cause of torticollis?
Congenital muscular torticollis
A worried mom brings a 1 mo baby to your clinic worried that her son may have a problem. You notice a soft, non-tender mass beneath the skin of the neck, attached to the SCM muscle. When you look at the baby, you notice that he sidebends his head toward the bump and rotates his chin to the opposite shoulder. What do you think it could be?
a) congenital torticollis
b) intermittent torticollis
c) acute adult torticollis
d) traumatic torticollis
e) spasmodic torticollis
a) congenital torticollis
A worried mom brings a 1 mo baby to your clinic worried that her son may have a problem. You notice a soft, non-tender mass beneath the skin of the neck, attached to the SCM muscle. When you look at the baby, you notice that he sidebends his head toward the bump and rotates his chin to the opposite shoulder. The crazed mom says that the last doctor she went to said it was a tumor and that the crazy guy wanted to take it out. Before you jump to any conclusions, which of the following symptoms could NOT be related?
a) hip displasia
b) tilting of the head toward the affected side to correct the diplopia when asking the baby to sit up
c) tilting of the head opposite of the affected side to correct the diplopia when asking the baby to sit up
b) tilting of the head toward the affected side to correct the diplopia
A worried mom brings a 1 mo baby to your clinic worried that her son may have a problem. You notice a soft, non-tender mass beneath the skin of the neck, attached to the SCM muscle. When you look at the baby, you notice that he sidebends his head toward the bump and rotates his chin to the opposite shoulder. The crazed mom says that the last doctor she went to said it was a tumor and that the crazy guy wanted to take it out. What should you tell the mom?
a) The last doctor is right! You should go with the surgery.
b) It will likely go away on it’s own within 6-12 weeks, but if it doesn’t, then she should definitely get it treated or else the child will be deformed forever!
c) You need to OMT it right away.
d) It’s easily treatable with some prescription medication.
b) It will likely go away on it’s own within 6-12 weeks, but if it doesn’t, then she should definitely get it treated or else the child will be deformed forever! [If not treated by 1 it can cause plagiocephaly (flattening of the head on the side of the contracture).
A 12 year old comes to your clinic with a C1-C2 subluxation, also known as a Grisel syndrome. What type of torticollis is this?
a) congenital torticollis
b) intermittent torticollis
c) acute adult torticollis
d) traumatic torticollis
e) spasmodic torticollis
b) intermittent torticollis
A 48 yo m comes in with a sudden onset of pain when he woke up. He says he wasn’t hit by anything in his sleep that he knows of, but it hurts A LOT. Upon examination you notice that he is sidebent over, and his head is markedly tilted to one side with the chin pointed to the opposite side of the spasm. When you ask him to lay down for examination, the patient has to prop up his head. What is one possible diagnosis for his condition?
a) congenital torticollis
b) intermittent torticollis
c) acute adult torticollis
d) traumatic torticollis
e) spasmodic torticollis
c) acute adult torticollis
A 48 yo m comes in with a sudden onset of pain when he woke up. He says he wasn’t hit by anything in his sleep that he knows of, but it hurts A LOT. Upon examination you notice that he is sidebent over toward the left side, and his head is markedly tilted to one side with the chin pointed to the opposite side of the spasm. When you ask him to lay down for examination, the patient has to prop up his head. You think it is acute adult torticollis, and to test it out, what would you ask the patient to do that you know should be nearly impossible unless he was malingering?
a) rotate toward the left
b) rotate toward the right
c) side bend toward the left
d) side bend toward the right
c) side bend toward the left
He should NOT be able to sidebend toward the side of the massive spasm
A 16 yo female patient comes into your clinic with torticollis. In addition, she reports a mild, persistent pain all over. What additional condition could she have since she has torticollis?
a) A case of the Joneses
b) A fever
c) C1-C2 herniated disk
d) Juvenile rheumatoid arthritis
d) Juvenile rheumatoid arthritis
A 28 yo f presents neck stifness. Originally she said she heard a “Cracking sound” when she had her car accident a few weeks ago. Now, she can’t turn her head in ANY direction, and she’s worried for the worst. You decide to take an Xray, and if this is indeed post-traumatic torticollis, what would you see?
a) no subluxation and some herniation
b) some subluxation and some herniation
c) some subluxation and no herniation
d) no sublaxation and no herniation
d) no sublaxation and no herniation
A 41 yo f comes to your clinic complaining of pain and stiffness in her neck. Upon observation you noticed that she has a sustained involuntary contraction of some of her cervical muscles that has lead to a twisting and repetitive head movements in abnormal postures. She mentions that the writhing motion started to spread to her face and jaw, as well as her arms. You decide to try some OMT, but you be able to overcome the spasm?
YES; if you use DIRECT treatment.
A 78 yo f comes to your clinic complaining of pain and stiffness in her neck. You realize it’s torticollis and send her for an Xray which comes back positive for a tumor. What kind of treatment options can you offer her?
None! :( Neurological torticollis is resistant to ALL treatments.
A 32 yo m patient comes into your office. As he walks through your door, you instantly notice repetitive tic-like motions that cause his head and shoulder to sidebend toward his right. When he sits down, he mentions you that it hurts to his right side and he can’t bend his head toward the spasm as much as he tries. What do you think he has?
a) congenital torticollis
b) intermittent torticollis
c) acute adult torticollis
d) traumatic torticollis
e) hysterical torticollis
e) hysterical torticollis
