Overview

Torticollis, also known as "wry neck," is a condition characterized by an abnormal, twisted, or tilted position of the head and neck. People with torticollis typically have the head tilted to one side while the chin points in the opposite direction. This condition can develop suddenly or gradually and may be temporary or permanent. Torticollis affects people of all ages, from newborns to adults, and can cause significant discomfort, restricted movement, and cosmetic concerns.

Causes

Torticollis can arise from a variety of underlying causes, and it is generally classified into congenital and acquired types:

• Congenital torticollis: Present at birth, often due to abnormal positioning in the womb or birth trauma affecting the sternocleidomastoid (SCM) muscle.
• Acquired torticollis: Develops later in life and can be caused by:
• Muscle strain or spasm due to poor posture or sudden neck movements.
• Infections like throat infections or upper respiratory infections leading to swollen lymph nodes or muscle inflammation.
• Trauma or injury to the neck muscles or cervical spine.
• Cervical dystonia, a neurological disorder causing involuntary neck muscle contractions.
• Drug-induced dystonia, often related to antipsychotic or anti-nausea medications.
• Abnormalities in the cervical spine such as herniated discs or vertebral anomalies.
• Visual problems causing compensatory head tilting.

Symptoms

The primary symptom of torticollis is the abnormal positioning of the head and neck. Additional symptoms include:

• Head tilt: The head tilts to one side, with the chin pointing in the opposite direction.
• Neck pain: Varying degrees of neck stiffness or soreness, especially in acquired cases.
• Limited range of motion: Difficulty turning the head or moving the neck freely.
• Muscle tightness: Noticeable tension or a lump in the affected neck muscle (common in congenital cases).
• Headache: Tension-type headaches may develop from chronic muscle strain.
• Facial asymmetry: In untreated congenital torticollis, the face may develop asymmetry over time.
• Neurological symptoms: In cervical dystonia, tremors, or involuntary muscle spasms may also be present.

Diagnosis

Diagnosing torticollis involves a combination of physical examination and, when necessary, imaging tests:

• Physical examination: A healthcare provider assesses head posture, neck range of motion, and palpates for muscle tightness.
• Medical history: Evaluation of onset, triggers, associated symptoms, and medication use.
• Imaging studies: X-rays, ultrasound (especially in infants), MRI, or CT scans may be used to identify structural abnormalities or muscle conditions.
• Neurological evaluation: In cases of cervical dystonia, further assessment of nerve function and muscle activity may be required.

Treatment

Treatment for torticollis depends on the underlying cause and severity of symptoms:

• Stretching exercises: Gentle physical therapy and stretching are first-line treatments for congenital torticollis in infants.
• Physical therapy: Targeted exercises improve muscle flexibility and strength in both children and adults.
• Pain management: Nonsteroidal anti-inflammatory drugs (NSAIDs) or muscle relaxants can relieve discomfort.
• Botulinum toxin injections (Botox): In cervical dystonia, Botox injections are highly effective in reducing muscle spasms.
• Warm compresses and massage: Help relieve muscle tightness and pain.
• Surgery: Rarely needed, but may be performed in resistant congenital torticollis or severe dystonia cases (e.g., muscle release surgery).
• Treatment of underlying causes: Managing infections, adjusting medications, or correcting vision problems can resolve secondary torticollis.

Prognosis

The prognosis for torticollis varies based on the cause and timely treatment:

• Congenital torticollis: Most infants improve significantly with early physiotherapy, often achieving full recovery within the first year of life.
• Acquired torticollis: Temporary torticollis due to minor injuries or muscle strain often resolves with conservative treatment.
• Cervical dystonia: While it is a chronic condition, symptoms can be effectively managed with Botox, medications, and physical therapy.
• Delayed treatment risks: Untreated cases may lead to chronic pain, restricted movement, or permanent facial asymmetry.

With early recognition and appropriate therapy, most people with torticollis can achieve significant symptom relief and improved quality of life.