Torticollis

Basics

Description

  • Torticollis is a symptom, not a disease
  • “Twisted neck” (L. tortus, twisted + collum, neck)
  • A fixed or dynamic posturing of the head and neck
  • Synonym(s):
    • Focal cervical dystonia
    • Wry neck

Epidemiology

  • Affects up to 90% of people in their lifetime
  • Male-to-female ratio 2:1
  • Most common age 30–50 yr

Etiology

Local

  • Spasmodic torticollis/focal cervical dystonia:
    • Most prevalent
    • Typically develops from sudden movement or physical stain
    • Identifiable event less than 20%
    • Often noted after waking from sleep
  • Self-limited, symptoms resolve in 1–2 wk
  • Spine and spinal column:
    • Cervical spine disease
    • Fracture
    • Dislocation, subluxation
    • Infections
    • Spondylosis
    • Tumor
    • Scar tissue–producing injuries
    • Ligamentous laxity in atlantoaxial region
  • Inflammatory diseases causing muscular damage:
    • Myositis
    • Lymphadenitis
    • Tuberculosis
    • Myasthenia gravis
    • Neuritis of the auriculotemporal branch of the trigeminal nerve
  • Infections of surrounding soft tissues:
    • Nasopharyngeal abscess
    • Retropharyngeal abscess
    • Cervical adenitis
    • Tonsillitis
    • Meningitis
    • Mastoiditis
    • Sinusitis
  • Dermatologic:
    • Injury, burn, or scar to the skin limits range of motion

Compensatory

  • Essential head tremor (tilt to suppress tremor)
  • Ocular muscle palsy (tilt to resolve diplopia)
  • Vestibular (tilt for balance)

Central

  • Neurological disorders:
    • Stroke
    • Trauma
  • Dystonias:
    • Torsion dystonia
    • Generalized tardive dystonia
    • Wilson disease
    • Levodopa therapy
    • Drug induced
    • Strychnine poisoning

Pediatric Considerations

  • Congenital:
    • Congenital fibrosis of sternocleidomastoid (SCM)
    • Odontoid hypoplasia
    • Hemivertebrae
    • Spina bifida
    • Arnold–Chiari syndrome
    • Pseudotumor of infancy
    • Hypertrophy or absence of cervical musculature
  • Otolaryngologic (Grisel syndrome): Subluxation of the atlantoaxial joint from inflammatory ligamentous laxity following an infectious process
    • Otitis media
    • Cervical adenitis
    • Retropharyngeal abscess
    • Pharyngitis
    • Mastoiditis
    • Vestibular dysfunction
    • Esophageal reflux
    • Syrinx with spinal cord tumor
  • Trauma:
    • Cervical fracture/dislocation
    • Clavicular fractures
    • Pneumomediastinum
  • Juvenile rheumatoid arthritis
  • Compensatory:
    • Strabismus (4th cranial nerve paresis)
    • Congenital nystagmus
    • Posterior fossa tumor
  • Central dystonias:
    • Torsion dystonia
    • Drug induced
    • Cerebral palsy

There's more to see -- the rest of this topic is available only to subscribers.