Torticollis

Inclination of the head to affected side in which sternocleidomastoid muscle is contracted.

A stiff neck caused by spasms of the neck muscles drawing the head to one side with the chin pointed to the other side. a condition of twisting of the neck that causes the head to rotate and tilt on an angle.

 

Etiology:

may be congenital or acquired.

Congenital Torticollis:

  • Unclear in Congenital muscular torticollis results when the sterno-mastoid muscle (ie, the strap that runs from beneath the angle of the jaw to the base of the neck above the collar bone) is shortened or tightened on one side.
  • Birth trauma or intrauterine malposition is also considered to cause damage to the sternocleidomastoid muscle in the neck. This results in a shortening or excessive contraction of the sternocleidomastoid muscle, often with limited range of motion in both rotation and lateral bending. The head is typically tilted in lateral bending toward the affected muscle and rotated toward the opposite side.

 

Acquired Torticollis:

  • Trauma to the neck can cause atlantoaxial rotatory subluxation, in which the two vertebrae closest to the skull slide with respect to each other, tearing stabilizing ligaments; this condition is treated with traction to reduce the subluxation, followed by bracing or casting until the ligamentous injury heals.
  • Tumors of the skull base (posterior fossa tumors) can compress the nerve supply to the neck and cause torticollis, and these problems must be treated surgically.
  • Infections in the posterior pharynx can irritate the nerves supplying the neck muscles and cause torticollis, and these infections may be treated with antibiotics if they are not too severe, but could require surgical debridement in intractable cases.
  • Ear infections and surgical removal of the adenoids can cause an entity known as Grisel’s Syndrome, a subluxation of the upper cervical joints, mostly the atlantoaxial joint, due to inflammatory laxity of the ligaments caused by an infection. This bridge must either be broken through manipulation of the neck, or surgically resected.
  • The use of certain drugs, such as  antipsychotics, can cause torticollis.
  • Treatment:

    1) Low-impact exercise to increase strong form neck stability. Gentle range of motion exercises
    2) Chiropractic manipulation of the neck.
    3) Extended heat application.
    4)  Massage.

    5) Surgery

    6) Neck brace support or immobilization

    Perry, A, G, Potter, P, A, Ross-Kerr, J, C and Wood, M, J. 2006. Canadian fundamentals of nursing. 3rded. Toronto: Elselvier

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