Torticollis

The Facts

In order for your neck to move the way it should, all the neck muscles, tendons, and bones must be healthy and functioning properly. Your neck muscles contract to produce movement and are connected to your bones by tendons. If you injure or overexert your neck, you can temporarily or permanently damage muscles, causing pain and a reduction in your normal range of motion.

Torticollis, also known as "wry neck," is a painful disorder of the muscles in the neck. Although the onset may occur at any age, most cases begin between the ages of 20 and 60 with a peak between the ages of 30 to 50. This condition is twice as common in women as in men. Torticollis involves an occasional or constant painful spasm of the large muscles of the neck and usually affects one side more than the other.

When a person's neck is in spasm due to torticollis, they may be forced to rotate and tilt their head forward, backward, or sideways. Some people find that the pain becomes worse when they sit, stand, or walk.

Torticollis is quite rare, affecting only 1 in every 10,000 people. It's extremely painful and can be very debilitating.

The Causes

Unfortunately, the cause of torticollis is unknown. However, it may be caused by conditions such as hyperthyroidism, nervous system infections, tardive dyskinesia (abnormal facial movements resulting from taking antipsychotic medications), some medications used for nausea or vomiting, and neck tumours. In addition, emotional difficulties may also contribute and even worsen the disorder, or in rare instances, they may be the underlying cause.

Occasionally, newborn babies can have a congenital form of torticollis. This type of torticollis can run in families or can be related to events during pregnancy or delivery. In older children, an imbalance of the eye muscles (such as strabismus) and bone or muscle deformities of the upper spine can also cause torticollis.

Symptoms And Complications

If you suffer from torticollis, you will probably experience sharp, painful muscle spasms in one side of your neck that may start suddenly and continue for a while or happen only periodically. Your head will probably be forced to tilt itself in a certain direction and even rotate depending on which neck muscles are affected. Sometimes, people with torticollis also experience spasms in other areas of their head such as their eyelids, face, or jaw, as well as in their hands. Spasms usually occur without warning and rarely during sleep.

Torticollis can vary from a mild case to one that's severe and constant. Young people who are moderately affected (about 10% to 20% of the people who actually have torticollis) will usually recover without treatment within 5 years. For most sufferers, however, the disorder may gradually increase and worsen for 1 to 5 years and then stabilize. Torticollis may also persist as a lifelong condition, producing continued pain and restricted movement of the neck, and eventually resulting in deformities to a person's posture.

Making A Diagnosis

In order to diagnose torticollis, a doctor will ask detailed questions about past injuries and other neck problems. He or she may choose to send the person for various imaging tests such as X-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI) to look for specific causes of the neck muscle spasms. However, it's unlikely the cause of the muscle spasms will be isolated.

In children and infants, doctors can detect neck muscle damage that may cause torticollis in a routine physical examination.

Treatment And Prevention

Torticollis can usually be treated quite successfully when the cause, such as abnormal bone growth or an abscess in the back of the throat, is identified. However, if the cause is a nervous system disorder or is unknown, treatment for torticollis is less likely to be successful in controlling painful spasms.

Some people's neck muscle spasms are relieved temporarily by physical therapy and massage. One method of massage that has had some success involves slight pressure, which is applied to the jaw on the same side as the head rotation. A cervical collar (either soft or stiff) may be helpful.

If physical therapy and massage don't work, some medications are available that may help reduce muscle spasms and involuntary movements. Medications can help control the pain caused by the spasms. Anticholinergic medications, which block specific nerve impulses, and benzodiazepines, which are tranquillizers, are commonly used. Muscle relaxants are also used.

The substance that causes botulism has been known to be effective in reducing pain and spasms if it's injected several times. It will also allow the head to be held in a more natural (less tilted) position. Improvement as a result of this treatment may last as long as several months.

Another treatment option involves surgically removing the nerves that supply sensation to the affected neck muscles. This treatment is sometimes successful but it should be tried only if other treatments have not provided any relief.

If emotional problems are thought to be contributing to the spasms, psychiatric treatment and counselling should be considered.

In infants with congenital torticollis, intensive physical therapy to stretch the damaged muscle should be started within the first few months after birth. It's extremely important to start therapy early because if it's unsuccessful or started too late, the child's neck muscles may have to be repaired by surgical means.