Torticollis

Question 1

What is torticollis?

Answer 1

= twisted neck

Question 2

What is the most common congenital cause of torticollis? What is it? Its outcome? Mx?

Answer 2

Congenital muscular torticollis:
○ Unilateral fibrous contracture of SCM
○ Mass is benign and self-limiting (resolves within weeks to months)
○ Manage with physiotherapy (education + stretching), tubular orthosis, surgery

Question 3

List some acquired causes of torticollis?

Answer 3

Trauma	
• Fracture
• Muscle spasm("wry neck")
• Spinal haematoma
• Breech delivery

Infection
• Head and neck: URTI, OM, mastoiditis, cervical adenitis, retropharyngeal abscess
• Spine: osteomyelitis, discitis, epidural abscess
• CNS: meningitis

Inflammation
• Juvenile arthritis

Neoplasm
• CNS tumours
• Bone tumours

Others
• Dystonic syndromes
• Ocular dysfunctione.g. vertical squint
• Atlantoaxial rotary fixation

Question 4

When should uncomplicated acute torticollis resolve by?

Answer 4

7-10 days

Question 5

What may you see at the SCM and face with torticollis?

Answer 5

• May see “tumour” of healing before complete scarring takes place in trauma!
• Hemi hypoplasia of the face - asymmetry in growth of facial skeleton as restriction of movement restricts growth (skeleton only grows with movement!)

Question 6

What are some general mx points for torticollis?

Answer 6

○ Analgesia or anti-inflammatory medications may be effective
○ Heat packs and massage may provide symptomatic relief in cases of wry neck
○ Diazepam can be effective with some cases of spasm of the SCM.

Question 7

What Rx should dystonic reactions receive?

Answer 7

benztropine