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Torticollis is a condition causing asymmetrical head or neck position due to a problem in the neck muscles.Torticollis, also known as wry neck, is a dystonic condition defined by an abnormal, asymmetrical head or neck position, which may be due to a variety of causes. The term torticollis is derived from the Latin words tortus for twisted and collum for neck.
causes:-
1. The cause is likely from the baby’s position in the uterus which leads to injury to the neck muscles.
2. Acquired torticollis may be caused by irritation to the cervical ligaments from a viral infection,
3.injury, or vigorous movement.Osseous
4.Additional causes may include:
1.Sleeping in an awkward position.Osseous
2.Traumatic
3.CNS/PNS
4.Ocular
5.Non-muscular soft tissue
6.Spasmodic
7.Drug induced
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types-
1.laterocollis : the head is tipped toward the shoulder,
2.rotational torticollis : the head rotates along the longitudinal axis,
3.anterocollis : forward flexion of the head and neck,
4.retrocollis : hyperextension of head and neck backward.
sign and symptom—
- Neck pain
- Occasional formation of a mass
- Thickened or tight sternocleidomastoid muscle
- Tenderness on the cervical spine
- Tremor in head
- Unequal shoulder heights
- Decreased neck movement
Anatomy of torticollis —
The underlying anatomical distortion causing torticollis is a shortened sternocleidomastoid muscle. This is the muscle of the neck that originates at the sternum and clavicle and inserts on the mastoid process of the temporal bone on the same side.There are two sternocleidomastoid muscles in the human body and when they both contract, the neck is flexed. The main blood supply for these muscles come from the occipital artery, superior thyroid artery, transverse scapular artery and transverse cervical artery. The main innervation to these muscles is from cranial nerve XI (the accessory nerve) but the second, third and fourth cervical nerves are also involved. Pathologies in these blood and nerve supplies can lead to torticollis.
treatment—
physiotherapy:–
Physical therapy is an option for treating torticollis in a non-invasive and cost-effective manner.
- Stretching the neck and trunk muscles actively. Parents can help promote this stretching at home with infant positioning. For example, prone positioning will encourage the child to lift their chin off the ground, thereby strengthening their bilateral neck and spine extensor muscles, and stretching their neck flexor muscles. Active rotation exercises in supine, sitting or prone position by using toys, lights and sounds to attract infant’s attention to turn neck and look toward the non-affected side.
- Stretching the muscle in a prone position passively.passive stretching is manual, and does not include infant involvement. Two people can be involved in these stretches, one person stabilizing the infant while the other holds the head and slowly brings it through the available range of motion. Passive stretching should not be painful to the child, and should be stopped if the child resists. Also, discontinue the stretch if changes in breathing or circulation are seen or felt.
- Stretching the muscle in a lateral position supported by a pillow (have infant lie on the side with the neck supported by pillow). Affected side should be against the pillow to deviate the neck towards the non-affected side.
- Environmental adaptations can control posture in strollers, car seats and swings (using U-shaped neck pillow or blankets to hold neck in neutral position)
- Passive cervical rotation (much like stretching when being supported by a pillow, have affected side down)
- Position infant in the crib with affected side by the wall so they must turn to the non-affected side to face out
Other treatments include:—
- Rest and analgesics for acute cases
- Diazepam or other muscle relaxants
- Botulinum toxin
- Encouraging active movements for children 6–8 months of age
- Ultrasound diathermy
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