TORTICOLLIS

(WRY NECK)
-Hitesh Rohit (3rd year BPT)
Content:-

■ Introduction
■ Causes
■ Clinical features
■ Diagnosis
■ Treatment
■ Complications
This is a deformity of the neck where the head and neck are
turned and twisted to one side.

It may be permanent, temporary,or spasmodic.

spasmodic torticollis is the commonest.

Most often,torticollis is secondary to pain and reflex muscle

spasm and recovers once the inflammatory process subsides.

Congenital torticollis,a common cause of permanent torticollis,is

of orthopaedic interest.
Causes of torticollis:-
Congenital Sterno-mastoid tumor

Infection Tonsillitis
Atlanto-axial infections
Labyrinthitis
Reflex spasm Acute disc prolapse (cervical)

Neurogenic Spasmodic condition

Paralytic condition

Ocular Compensation for squint

Others Rheumatoid arthritis

Spasmodic torticollis
 Congenital torticollis:
■ The sterno-mastoid muscle on one side of the neck is fibrosed and fails to
elongate as the child grows,and thus results in a progressive deformity.
■ The cause of fibrosis is not known,but it is possibly a result of ischemic
necrosis of the sterno-mastoid muscle at birth.
■ Evidence in favour of this theory is the presence of a lump in the sterno-
mastoid muscle in the first few weeks of life, probably a swollen ischaemic
muscle.
■ This is termed sterno-mastoid tumor.
■ The lump disappears spontaneously within a few months, leaving a fibrosed
muscle.
■ Torticollis commonly occurs in a children with breech presentation.
Clinical features:-
■ Limited range of motion of the head
■ Headache
■ Head tremor
■ Neck pain
■ Shoulder, that is higher on one side of the body.
■ Stiffness of the neck muscles.
■ Swelling of the neck muscles(possibly present at birth)
■ The baby’s head may be flattened
Diagnosis:-
■ The child usually presents at 3-4 years of age, often as late as puberty.
■ The head is tilted to one side so that the chin faces to the opposite side.
■ The sterno-mastoid is prominent on the side the head tilts,and becomes more
prominent on trying to passively correct the head tilt.
■ In cases presenting in the first few weeks of life,a lump may be felt in the
sterno-mastoid muscle.
■ Facial asymmetry develops in cases who present later in life.
■ Radiological examination is normal,and is carried out to rule out an
underlying bone defect such as scoliosis.
Treatment:-
■ In a child presenting with a sterno-mastoid tumor,progress to torticollis
can be prevented by passive stretching and splinting.
■ The same may also be sufficient for mild deformities in younger children.
■ For severe deformities, especially in older children, release of the
contracted sterno-mastoid muscle is required.
■ It is usually released from its lower attachment,but sometimes both
attachments need to be released.
■ Following surgery,the neck is maintained in the corrected position in a
callot’s cast.
■ For older children with torticollis related to the infection or
infammation, treatment may include:-
Antibiotics for specific infection.
Rest
Anti inflammatory medications (such as ibuprofen)
Passive motion to keep the muscles from getting stiff.
Surgery if indicated.
Complications:-

■ Muscle swelling due to constant tension.

■ Nervous system symptoms due to pressure on nerve roots.
Reference:-

■ Essential orthopaedics by J.Maheshwari

धन्यवाद ✨