Torticollis
Fast facts
- Torticollis is when the neck is twisted to one side as a result of muscle spasms.
- Torticollis can appear in both children and adults. It can develop as a result of injuries, certain infections or other causes.
- A range of treatments can be used to treat torticollis, including physiotherapy, neck braces, medications, Botox® injections, and surgery.
- Treatment for torticollis is usually effective, especially if it starts early.
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Infections
Entry into the body of microorganisms that can reproduce and cause disease.
What is torticollis?
Torticollis, also known as 'twisted neck', 'wry neck' or 'wryneck', is a persistent twisting of the neck to one side, as a result of spasms in the muscles that control neck movement.
Causes
Torticollis is a condition that can be present from birth (congenital), or develop later in life (acquired) due to a range of reasons.
Congenital torticollis
It is unknown exactly what causes congenital torticollis; however, it is thought that it may be related to muscle or bone injury before or during a baby's birth.
Injury or inflammation
Torticollis can be caused by injury to or inflammation of muscles, such as the trapezius and sternocleidomastoid muscles that control neck movements. Similarly, injuries to the spine such as acute disc prolapse, are also known causes of torticollis.
Infection
Bacterial or viral infections that affect the head and neck, central nervous system or the spine (such as osteomyelitis) can cause torticollis.
Ocular torticollis
In some children, problems with the eye muscles can affect the horizontal motion of the eyes. In order to improve their limited vision, the child will constantly tilt their head. This movement can lead to torticollis developing.
Spine and nervous system disorders
Many problems of the nerves and the spinal column can cause torticollis. These can include:
- Grisel's syndrome - an inflammation of the joint between the top two vertebrae in the spinal column (atlantoaxial joint);
- Klippel-Feil syndrome - a genetic disorder in which neck vertebrae are fused (joined) to each other;
- Syringomyelia - a cyst formed along the spinal column;
- Arnold-Chiari malformation - a condition in which sections of the brain are located lower in the skull than normal, pressing down on the spinal column;
- Spine tumours, and;
- Sandifer's syndrome - a condition of unknown cause that causes spasms, seizures and heartburn.
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Central nervous system
The part of the body's nervous system that includes the brain and the spinal cord.
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Infections
Entry into the body of microorganisms that can reproduce and cause disease.
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Inflammation
A body’s protective immune response to injury or infection. The accumulation of fluid, cells and proteins at the site of an infection or physical injury, resulting in swelling, heat, redness, pain and loss of function.
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Disc prolapse
Degeneration of or injury to a disc in the spine, which causes the jelly-like core to push against or leak outside the disc. This results in back pain. Also known as 'slipped' disc.
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Nerves
One or more fibres that transmit signals of sensation and motion between the brain or spinal cord and other parts of the body.
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Osteomyelitis
Infection of the bone or bone marrow. It is usually caused by bacteria and can occur because of trauma to the bones, surgery or from infections in other parts of the body.
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Seizures
A sudden, involuntary contraction of muscle groups caused by abnormal electrical activity in the brain.
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Viral
Pertaining to an illness caused by a virus.
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Spinal column
The bony structure that comprises the individual vertebrae that enclose and protect the spinal cord and nerves located in the middle.
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Bacterial
Relating to bacteria, which are microscopic organisms with DNA, but no definite nucleus. They are capable of causing many diseases in humans.
Signs and symptoms
The various signs and symptoms associated with torticollis in adults include:
- Tilting of the head to one side, with the chin pointing the other way;
- A painful neck that is difficult to move and turn, and;
- Stiff and swollen neck muscles.
In babies and young children, these signs can appear as:
- A hard lump on the side of the neck;
- A preference for one breast during breastfeeding;
- A flat head, known as positional plagiocephaly, and;
- Uneven facial features.
Methods for diagnosis
Torticollis can be diagnosed from a physical examination. An imaging technique, such as an ultrasound, may also assist with the diagnosis.
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Ultrasound
A scan that uses high-frequency soundwaves to produce images of the body’s internal structures.
Types of treatment
A range of treatments can be used to treat or relieve torticollis.
These can include:
- Physiotherapy, which uses specific stretching exercises to relieve muscular tension;
- A neck brace (cervical collar) can help maintain correct posture to stabilise the neck muscles;
- Anti-inflammatory medication, to relieve pain and inflammation;
- Antibiotics, if the cause of torticollis is a bacterial infection;
- A botulinum toxin injection (commonly known as Botox®) into the neck muscles, to provide relaxation that can last for several weeks. This treatment can be repeated periodically, and;
- Surgery may be advised in some cases of children affected by torticollis who have not responded to other treatments.
For infants in particular, treatment of torticollis should start as early as possible to prevent development of uneven facial features.
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Inflammation
A body’s protective immune response to injury or infection. The accumulation of fluid, cells and proteins at the site of an infection or physical injury, resulting in swelling, heat, redness, pain and loss of function.
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Bacterial
Relating to bacteria, which are microscopic organisms with DNA, but no definite nucleus. They are capable of causing many diseases in humans.
Prognosis
Torticollis can often go away naturally. However, in infants it is best to treat it promptly to avoid any complications.
Torticollis treatment is usually effective.
Potential complications
If torticollis continues, over time the neck muscles may become swollen, resulting in pain and discomfort. Your peripheral (side) vision will be limited by the twist in the neck.
In children, if the tilt is not corrected, potential complications include uneven facial features and incorrect muscle development.
Prevention
There is not much you can do to prevent torticollis, other than maintaining a good sleep posture and trying not to strain your neck. If torticollis appears in your child, treating it early will help relieve it faster and prevent the condition from worsening.
10 Most frequently asked questions (FAQs)
Torticollis is a persistent twisting of the neck due to problems in the muscles responsible for neck movement. What are the symptoms of torticollis? With torticollis, the head is tilted to the side with the chin pointing the other way. The neck may be painful, hard to move and rotate, and the neck muscles are stiff and swollen. It is usually first noticed when waking from sleep. Torticollis can be present from birth (congenital) or develop later in life (acquired). Torticollis can be the result of Injury or inflammation of the muscles that control the neck (the trapezius and sternocleidomastoid), infections, or a variety of spine and nervous system disorders. The cause of congenital torticollis is not known, but it may be due to problems in positions of the head and neck during pregnancy and/or birth. What is ocular torticollis? In some children, problems with eye muscles make it hard for the child to control horizontal motion of the eyes. To compensate for that and to see properly, the child starts tilting their head. If this behaviour persists and the vision problem is not treated, the child will develop torticollis. How is torticollis diagnosed? Torticollis can be diagnosed from a physical examination. An imaging technique, such as an ultrasound, may also assist with the diagnosis. How is torticollis treated? Torticollis is normally treated with physiotherapy. A doctor can demonstrate special stretching exercises that will normally help to relieve torticollis. A neck brace (cervical collar) can stabilise the neck and help maintain correct posture. For infections and inflammation, the appropriate medications will help relieve torticollis. In serious cases, however, surgery may be required. Can torticollis be prevented? There is not much you can do to prevent torticollis, other than maintaining a good sleep posture and trying not to strain your neck. If torticollis appears in your child, treating it early will help relieve it faster and prevent the condition from worsening.
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