5-Minute Emergency Consult
Torticollis
Torticollis is a topic covered in the 5-Minute Emergency Consult.
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Basics
Description
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): Cervical dystonia, wry neck
Etiology
LocalEtiology
- Acute wry neck:
- Develops overnight without provocation
- Most prevalent
- Self-limited, symptoms resolve in 1 to 2 wk
- Cervical spine disease
- Fracture
- Dislocation, subluxation
- Infections
- Spondylosis
- Tumor
- Scar tissue–producing injuries
- Ligamentous laxity in atlantoaxial region
- Inflammatory disease 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
- Tilt with essential head tremor (patient tilts head to suppress tremor)
- Ocular muscle palsy
- Idiopathic spasmodic torticollis:
- Female > male
- Onset 31–60 yr old
- Dystonias:
- Torsion dystonia
- Generalized tardive dystonia
- Wilson disease
- λ-Dopa therapy
- Acute (neuroleptic drugs)
- Strychnine poisoning
Pediatric Considerations
Local
- Congenital:
- Odontoid hypoplasia
- Hemivertebrae
- Spina bifida
- Arnold–Chiari syndrome
- Pseudotumor of infancy
- Hypertrophy or absence of cervical musculature
- Otolaryngologic:
- Vestibular dysfunction
- Otitis media
- Cervical adenitis
- Retropharyngeal abscess
- Pharyngitis
- Mastoiditis
- 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
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Basics
Description
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): Cervical dystonia, wry neck
Etiology
LocalEtiology
- Acute wry neck:
- Develops overnight without provocation
- Most prevalent
- Self-limited, symptoms resolve in 1 to 2 wk
- Cervical spine disease
- Fracture
- Dislocation, subluxation
- Infections
- Spondylosis
- Tumor
- Scar tissue–producing injuries
- Ligamentous laxity in atlantoaxial region
- Inflammatory disease 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
- Tilt with essential head tremor (patient tilts head to suppress tremor)
- Ocular muscle palsy
- Idiopathic spasmodic torticollis:
- Female > male
- Onset 31–60 yr old
- Dystonias:
- Torsion dystonia
- Generalized tardive dystonia
- Wilson disease
- λ-Dopa therapy
- Acute (neuroleptic drugs)
- Strychnine poisoning
Pediatric Considerations
Local
- Congenital:
- Odontoid hypoplasia
- Hemivertebrae
- Spina bifida
- Arnold–Chiari syndrome
- Pseudotumor of infancy
- Hypertrophy or absence of cervical musculature
- Otolaryngologic:
- Vestibular dysfunction
- Otitis media
- Cervical adenitis
- Retropharyngeal abscess
- Pharyngitis
- Mastoiditis
- 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
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Citation
Rosen, Peter, et al., editors. "Torticollis." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307476/all/Torticollis.
Torticollis. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307476/all/Torticollis. Accessed January 24, 2020.
Torticollis. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307476/all/Torticollis
Torticollis [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2020 January 24]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307476/all/Torticollis.
* Article titles in AMA citation format should be in sentence-case
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ED - Schaider,Jeffrey J,
BT - 5-Minute Emergency Consult
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PB - Lippincott Williams & Wilkins
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