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Torticollis

Spasmodic torticollis; Wry neck; Loxia; Cervical dystonia; Cock-robin deformity; Twisted neck; Grisel syndrome

Torticollis is a condition in which the neck muscles cause the head to tilt, turn or rotate to the side.

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Causes

Torticollis may be:

• Due to changes in genes, often passed down in the family
• Due to problems in the nervous system, upper spine, or muscles

The condition may also occur without a known cause.

With torticollis present at birth, it may occur if:

• The baby's head was in the wrong position while growing in the womb
• The muscles or blood supply to the neck were injured

Symptoms

Symptoms of torticollis include:

• Limited movement of the head
• Headache
• Head tremor
• Neck pain
• Shoulder that is higher than the other
• Stiffness of the neck muscles
• Swelling of the neck muscles (possibly present at birth)

Exams and Tests

The health care provider will perform a physical exam. The exam may show:

• The head is rotated, tilted, or leaning forward or backward. In severe cases, the entire head is pulled and turned to one side.
• Shortened or larger neck muscles.

Tests that may be done include:

• X-ray of the neck
• CT scan of the head and neck
• Electromyogram (EMG) to see which muscles are most affected
• MRI of the head and neck
• Blood tests to look for medical conditions that are linked to torticollis

Treatment

Treating torticollis that is present at birth involves stretching the shortened neck muscle. Passive stretching and positioning are used in infants and small children. In passive stretching, a device such as strap, a person, or something else is used to hold the body part in a certain position. These treatments are often successful, especially if they are started within 3 months of birth.

Surgery to correct the neck muscle may be done in the preschool years, if other treatment methods fail.

Torticollis that is caused by damage to the nervous system, spine, or muscles is treated by finding the cause of the disorder and treating it. Depending on the cause, treatment may include:

• Physical therapy (applying heat, traction to the neck, and massage to help relieve head and neck pain).
• Stretching exercises and neck braces to help with muscle spasms.
• Taking medicines such as baclofen to reduce neck muscle contractions.
• Injecting botulinum toxin.
• Trigger point injections to relieve pain at a particular point.
• Surgery of the spine might be needed when the torticollis is due to dislocated vertebrae. In some cases, surgery involves destroying some of the nerves in the neck muscles, or using brain stimulation.

Outlook (Prognosis)

The condition may be easier to treat in infants and children. If torticollis becomes chronic, numbness and tingling may develop due to pressure on the nerve roots in the neck.

Possible Complications

Complications in children may include:

• Flat head syndrome
• Deformity of the face due to lack of sternomastoid muscle movement

Complications in adults may include:

• Muscle swelling due to constant tension
• Nervous system symptoms due to pressure on nerve roots

When to Contact a Medical Professional

Contact your provider for an appointment if symptoms do not improve with treatment, or if new symptoms develop.

Torticollis that occurs after an injury or with illness may be serious. Seek medical help right away if this occurs.

Prevention

While there is no known way to prevent this condition, early treatment may prevent it from getting worse.

References

Liu RW, Thompson GH. Musculoskeletal disorders in neonates. In: Martin RJ, Fanaroff AA, Walsh MC, eds. Fanaroff and Martin's Neonatal-Perinatal Medicine. 11th ed. Philadelphia, PA: Elsevier; 2020:chap 97.

Marcdante KJ, Kleigman RM, Schuh AM. Spine. In: Marcdante KJ, Kleigman RM, Schuh AM, eds. Nelson Essentials of Pediatrics. 9th ed. Philadelphia, PA: Elsevier; 2023:chap 202.

White KK, Bouchard M, Goldberg MJ. Common neonatal orthopedic conditions. In: Gleason CA, Juul SE, eds. Avery's Diseases of the Newborn. 10th ed. Philadelphia, PA: Elsevier; 2018:chap 101.

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Review Date: 4/25/2022  

Reviewed By: Joseph V. Campellone, MD, Department of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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