Torticollis

 Presented To
Dr Hira
 Presented by
Tehzeeb Arif. Zainab. Aliya
Mehreen Khalid. Ahmed. Anfal
Nifra Muhammad Junaid
What is torticollis

 Torticollis a medical condition characterized by The involuntary contraction or spasm of the Muscles of the
neck Leading to abnormal position of the head and neck
 It can manifest in various form including Tilting of the head in on side or rotation of the head Or a
combination of both
 It is derived from the latin word ‘tortus’ (twisted) and ‘collum’ (neck)
 It is also known as wry neck
Presentation of torticollis

Torticollis is fixed or dyanamic tilt ,rotation with flexion and extension of the head or neck .The types of
torticollis depends on position of head or neck
Laterocollis---The head is tipped towards the shoulder
Rotational torticollis –The head rotates along the longitudinal axis
Anterocollis --- Forward flexion of the head and neck
 Retrocollis--- hyperextension of head and neck backwards
Causes of torticollis

The Shortening of one of your baby’s sternocleidomastoid muscles (SCMs) causes congenital torticollis. Your
SCMs are two large muscles in your neck. They connect the back of your skull to your breastbone (sternum) and
collarbone (clavicle). Researchers aren’t sure why one of these muscles shortens in some babies. It may be due
to:
The way your baby was positioned in your womb (uterus).
An abnormal development in the SCM.
A collection of blood in your baby’s neck muscles (hematoma).
Abnormal thickening of your baby’s muscle tissue (fibrosis).
 Klippel-Feil syndrome, a rare birth defect that causes the vertebrae in your baby’s neck to fuse.
 Aquired torticollis frequently occurs because of swelling in your child’s throat. The swelling causes the tissues
surrounding your child’s upper spine to loosen. This allows their vertebrae to move out of their normal position.
This causes their neck muscles to spasm, causing their head to tilt to one side. The swelling may be due to an
infection, an injury or an unknown reason. Other causes of acquired torticollis may include:
Gastroesophageal reflux (GERD).
Vision problems.
Reaction to certain medications.
Scar tissue.
Arthritis of the neck (cervical spondylosis).
 Sandifer syndrome, a rare condition that combines GERD with neck spasms.
Symptoms of torticollis

The following are the most common symptoms of torticollis. However, each person may experience symptoms
differently. Symptoms may include:

Neck muscle pain or pain down the spine

Inability to turn the head, usually holding it twisted to one side
Spasm of the neck muscles
Awkward position of the chin
The symptoms of torticollis may resemble other conditions and medical problems. Always consult your healthcare
provider for a diagnosis.
In babies

When they’re about 2–4 weeks old, a baby with torticollis might:
tilt the head in one direction (this can be hard to notice in very young infants)
not fully turn their head to follow you.
If breastfed, have trouble breastfeeding on one side (or prefer one breast only)
 work hard to turn toward you.
In Adults

The following are the most common symptoms of torticollis. However, each person may experience symptoms
differently. Symptoms may include:
Neck muscle pain or pain down the spine
Inability to turn the head, usually holding it twisted to one side
Spasm of the neck muscles
Awkward position of the chin
 The symptoms of torticollis may resemble other conditions and medical problems. Always consult your
healthcare provider for a diagnosis.
Types of torticollis

Congenital muscular torticollis Postural torticollis

Ocular (Trochlear )
Spasmodic torticollis (wry neck )
torticollis

Acute torticollis
Congenital muscular torticollis
POSTURAL TORTICOLIS

 Postural torticollis is a painless condition that typically presents during infancy. The condition usually
resolves within a few months without the need for operative treatment. Potential complications include
cervical scoliosis with compensatory thoracic scoliosis, facial asymmetry, and plagiocephaly.
Acute torticollis

Acute torticollis occurs suddenly when you wake up with pain and stiffness down one side of your neck
 The stiffness causes neck to twist to one side of your neck
 It can be result of blunt trauma to head and neck or from simply sleeping in an awkward position
Spasmodic Trochlear

Recurrent or transient contraction of the muscles of

Congenital fourth nerve palsy
the neck muscles
This is unrelated to SCM
SCM is mostly involved
 Caused by damage to the Trochlear nerve that
 Cervical dystonia, idiopathic cervical dystonia,
supplies superior oblique muscle of eye.
intermittent torticollis
Diagnosis

 Diagnosis of torticolis exams include

 radiography (X-ray)
 computed tomography (CT)
 ultrasound imaging,
 In cases of spasmodic torticollis, the pain is unilateral and can radiate to the shoulder, and there is muscle
stiffness.
 Gold standard for diagnosing congenital muscular torticollis is ultrasound examination (US) of the SCM
Physical examination

 Your baby’s healthcare provider will perform a physical examination to diagnose torticollis. They’ll look at
how far your baby’s head is twisted or tilted.
 They’ll also examine your baby’s neck and look for swollen or stiff muscles.
Assessment

 The Muscle Function Scale (MFS) is a tool used to

assess the function of the lateral flexors of the neck in
infants, using a scale of 0 to 6
 1. Physical and Neurological Exam: The doctor examines your child's head and neck for torticollis type.
 2. Range of Motion Check: Assessing head and neck movement capabilities.
 3. Palpation of SCM Muscle: Detecting a lump in the neck, common in congenital muscular torticollis cases.
 4. Facial Asymmetry Check: Looking for unevenness which could indicate plagiocephaly.
 5. Hip Examination: Evaluating hip rotation due to potential association with hip dysplasia.
 6. Additional Imaging: Ultrasound or other imaging may be requested to detect spine abnormalities
indicating serious health issues.
How do u measure torticollis

 The most representative assessment methods for

assessing congenital torticollis include an assessment
of the passive cervical range of motion using an
arthrodial goniometer (can be done by physical
therapists), as well as an active range of motion, and
global assessment
 Physiotherapy management

 Picking baby up. When picking your baby up, first roll him on his
left side, keeping his right side up. Next, slowly lift your baby. You
should notice that your baby starts to lift his head up. Try this when
it’s time to change the diaper, or when picking your baby up from the
crib or floor.
 Carry your baby tilted sideways with her right side up. Try to tilt
your baby at several different angles to strengthen the muscle through
the entire range. You should notice your baby’s eyes leveling up
towards a horizontal line. Try to make a habit of carrying your baby
this way, instead of on your hip or against your chest.
Horsey ride While you are sitting, straddle your baby across one of your thighs. Face your baby forward.
Slowly tilt your baby to the left, keeping the right side up. Try to cover as many angles as possible. You should
notice your baby’s eyes leveling up toward a horizontal line.
 Seat tilt. While your baby is sitting to play or eat, use a wedge under his right buttock (bum!). This will help
your baby work the muscles For a longer time. You must stay with your baby all the time when doing this
exercise.
Tummy time

Tummy time will help:

• Keep your baby’s head nice and round, or to re-shape it if it has started to flatten
• Strengthen your baby’s neck and shoulders
 • Develop skills like sitting, crawling and walking
 Try to have your baby play on her belly as often and for as long as she can. Keep trying, even if your baby
doesn’t like this position. If your baby keeps crying, try shorter ‘tummy time’ periods more often.
 • Use a rolled up towel under your baby’s chest for more support
 • Use your own leg instead of a roll
 • Try a softer surface
 • Place your baby on your tummy when you are lying down.