Torticollis

• 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.

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.

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.

Torticollis. 

Methods for diagnosis

Torticollis can be diagnosed from a physical examination. An imaging technique, such as an ultrasound, may also assist with the diagnosis.

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.

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.