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LeFebvre > B10 Torticollis > Flashcards

B10 Torticollis Flashcards

1
Q

What is torticollis?

A

A painful contraction of muscles (usually SCM) resulting in an unnatural head position

AKA wry neck

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2
Q

What is the most common head position that presents for Torticollis?

A

Rotated and flexed

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3
Q

What are the two etiologies of congenital torticollis?

A
  • birth trauma (muscular lesion, short/missing SCM)

- bony anomaly (hemi vertebrae, congenital fusion of c-spine vertebra, etc)

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4
Q

What percentage of patients with congenital muscular torticollis respond to passive stretching within the first year of life?

A

90%

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5
Q

Some patients undergo selective denervation for torticollis instead of passive stretching. What percentage of these patients experience satisfactory results?

A

65-80%

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6
Q

What is AARS? Why is it important?

A

atlantoaxial rotary subluxation which can present similar to torticollis and therefore is important to rule out

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7
Q

What causes AARS?

A

It is thought to be precipitated by retropharyngeal edema leading to laxity of ligaments at C1-C2. This can occur after:

  • Minor surgery
  • Pharyngeal surgery
  • Inflammatory process
  • Upper respiratory tract infection
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8
Q

What are the 4 different types of torticollis and which is most common?

A
  • non-traumatic/uncomplicated acute torticollis (most common)
  • traumatic acute torticollis
  • cervical dystonia/spasmodic torticollis
  • post traumatic/delayed dystonia
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9
Q

What type of torticollis develops overnight and results in painful, palpable neck spasms the following morning?

A

Acute uncomplicated/non-traumatic torticollis

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10
Q

What is the treatments for Acute uncomplicated/non-traumatic torticollis?

A

It is usually self-limited and resolves on its own in days to weeks. If treated, conservative care can be done:

  • PIR, reciprocal inhibition, etc. to relax the SCM spasm
  • manipulate joint dysfunction if present
  • analgesics as needed
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11
Q

What is the relationship between Acute uncomplicated/non-traumatic torticollis and joint dysfunction?

A

Upper cervical spine joint dysfunction can result in reflex spasm of the SCM and other cervical muscles, resulting in torticollis. Upper cervical may reflex directly to CN XI

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12
Q

What type of torticollis results from blunt trauma to the head and neck, such as concussion or whiplash?

A

Acute traumatic torticollis

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13
Q

What is the first step in treatment of acute traumatic torticollis?

A

Immobilize and take radiographs

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14
Q

Torticollis can be secondary to what life-threatening diseases?

A
  • Retropharyngeal abscess
  • spinal epidural hematomas
  • tumors
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15
Q

Why is it important to rule out infectious cause of torticollis first?

A

Because retropharyngeal abscess is potentially life-threatening

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16
Q

Who typically gets retropharyngeal abscesses?

A

Children aged 2-4 but incidence in adults is increasing

17
Q

What is the typical presentation of torticollis secondary to retropharyngeal abscess?

A
  • neck discomfort
  • fever
  • stridor (harsh vibration when breathing)
  • dysphagia (difficulty swallowing)
  • drooling
  • odynophagia (painful swallowing)
  • respiratory distress
18
Q

Other than spinal epidural hemoatomas, tumors and retropharyngeal abscesses, what other non-life threatening diseases can torticollis be secondary to?

A
  • upper respiratory infection
  • tooth infection
  • pharyngitis
  • tonsillitis
  • systemic infection
  • meningitis
  • osteomyelitis
  • upper lobe pneumonia
  • neurogenic from viral infection of CN XI
  • psychiatric disease
19
Q

What medications can cause torticollis?

A
  • dopamine receptor blockers
  • metoclopramide
  • phenytoin
  • carbamazepine
20
Q

What mechanical neck lesions can cause torticollis?

A
  • spondylolysis
  • scar tissue
  • ligamentous laxity in atlantoaxial region
21
Q

What is dystonia?

A

A movement disorder that causes involuntary muscle contractions resulting in twisting and/or repetitive movements that are sometimes painful

22
Q

What is the theory behind the cause of dystonia?

A

Researchers think it is due to a problem in the part of the brain that handles messages about muscle contractions. Thalamic or basal ganglia lesion has been suspected.

23
Q

What are some additional symptoms associated with dystonia?

A
  • tremors
  • voice problems
  • dragging foot
24
Q

What are the three different types of cervical dystonia?

A
  • idiopathic spasmodic torticollis
  • post traumatic torticollis
  • UMNL of cranial nerve XI
25
Q

A chronic, slowly progressive form of
torticollis that is characterized by having an acquired,
nontraumatic origin and consists of episodic tonic and/or clonic involuntary contractions of neck muscles.

A

Idiopathic spasmodic torticollis

26
Q

Who typically gets idiopathic spasmodic torticollis?

A
  • females

- 30-60 years old

27
Q

What are some additional symptoms that can occur with idiopathic spasmodic torticollis?

A
  • dystonic symptoms can progress to hand, arm or oromandicular region (32%)
  • dysphagia
  • tremor (71%)
  • pain (68%)
28
Q

What activities worsen the symptoms of torticollis and dystonia (Both varieties)?

A
  • standing
  • walking
  • emotional stress
29
Q

What finding from the history can help distinguish idiopathic and delayed post-traumatic spasmodic torticollis from acute traumatic and acute non-traumatic torticollis?

A

Patients reporting the presence of sensory tricks that reduce head and neck movements would indicated spasmodic torticollis/dystonia over acute torticollis

30
Q

What is the prognosis for idiopathic spasmodic torticollis?

A

Symptoms last more than 6 months and result in considerable somatic and psychologic disability.

31
Q

Of patients with cervical dystonia, what percentage

experience spontaneous self-limited remissions that may be quite brief or last as long as 2-3 years?

A

10-20%

32
Q

Posttraumatic cervical dystonia has a delayed onset. How long does it take for symptoms to occur?

A

days to weeks and as long as 3-12 months after head

and neck trauma

33
Q

With torticollis, the primary goal of physical examination is to differentiate between acute torticollis and cervical dystonia, rule out disease, atlas subluxation, fracture and structural instability. What physical exam procedures should be done to do this?

A
  • take temperature
  • examine throat
  • ausculatate
  • observe for craniofacial asymmetry
  • observe for head and UE tremors
  • palpate lymph nodes
  • perform neuro ortho exam
  • assess SCM
  • palpate spine, especially upper cervicals
34
Q

What ancillary studies should be done in the management of torticollis?

A

None are usually necessary

  • Xray if there has been trauma, atlas subluxation is suspected of retropharyngeal infection is suspected
  • MRI or CT if CNS disease is suspected
35
Q

What is the treatment for dystonia?

A
  • lengthen SCM
  • decrease fibrosis
  • Heat
  • Electrotherapy (but not over anterior neck)
36
Q

What is the prognosis for dystonia?

A

May self resolve or take up to 12 months to resolve with treatment

37
Q

What are some medical interventions for dystonia?

A
  • Botox injections
  • NSAIDs
  • muscle relaxants
  • anticholinergics

LeFebvre (29 decks)

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