TORTICOLLIS
This article would target the areas below:
1. Definition of torticollis2. Types of torticollis
3. Causes/risk factors of torticollis
4. Signs and symptoms of torticollis
5. How to diagnose torticollis
6. The physiotherapy management of torticollis.
DEFINITION OF TORTICOLLIS
The human neck compose of several muscles such as sternocleidomastoid(SCM), splenius capitis,scalenes, trapezius,and levator scapulae Etc. These muscles assist in neck movement.
Torticollis is a rare condition that occurs as a result of a shortened or weakness of sternocleidomastoid muscle. Adults, children, and infants can be affected by torticollis.
The sternocleidomastoid muscle is found on each sides of the neck.
One of its functions helps in the rotational, and bending movement of the neck. shortness/ tightness of the SCM muscle results in tilting of the neck towards one side. The head can tilts backward, laterally or forward.The SCM is a prime mover for the neck. The term torticollis is known in latin as a twisted neck. It is also referred to as wryneck or loxia.
Torticollis can be painful or painless. Often, during passive stretch, patient may feel pain or may not feel pain.
TYPES OF TORTICOLLIS
There are two main types of torticollis. Namely;
● Temporary torticollis
● Fixed torticollis{congenital muscular torticollis-CMT, klippel-feil syndrome, & cervical dystonia- sub-divisions of fixed torticollis}
Temporary torticollis: This type of torticollis affect individuals for about 1-2 days and disappears. It may not require any treatment but requires enough rest to prevent unnessary neck movements.
Inflammation of lymph nodes after infection,or cold may cause
temporary torticollis. Neck injury which makes the cervical bones swell can also be a causal agent.
Fixed torticollis: This type of torticollis is also known as permanent torticollis. It occurs as a result of an underlying problem with the patient muscle or bone structure. It can also develops as a result of tumor growth on the spinal cord that put pressure on the nerve(cervical region).
Fixed torticollis has three sub-types:
● Congenital muscular torticollis(CMT)
● Klippel-feil syndrome
● Cervical dytonia(spasmodic torticollis).
★ Congenital muscular torticollis(CMT): This is the most common
form of a fixed torticollis that affects infants and diagnosed mostly
within the first 2 months of life. It is often caused by birth trauma or
sleeping in one position for a prolonged period of time.
★ Klippel-feil syndrome: This is another type of fixed torticollis and a congenital condition. It occurs as a results of an abnormal
development of the cervical bones. The bones could either be fused, or have an irregular shape than normal resulting in a twisted neck.
★ Cervical dystonia(spasmodic torticollis):Cervical dystonia is a rarer form of a fixed torticollis that causes the neck muscles to spasm. People with cervical dystonia experience painful episodes where the neck muscles contract and the head twists to one side, forward, or backward.
CAUSES/RISK FACTORS
In adults, the cause of wryneck may be;
● Injury to the neck or spine, where inflammation causes the muscles to contract or spasm.
● Infection of the neck or head, where inflammation causes the muscles to contract or spasm.
● Abscesses in the throat or upper airway.
● Infections of other parts of the body, such as ears, sinuses, jaw, teeth, or scalp.
● Scar tissue
● Arthritis of the cervical spine
● Neck tumors
Wryneck in infants may be as a result of;
● Trauma during birth; breached delivery where the baby remains in the birth canal in the same position for a prolonged period of time.
Overweight babies that need to be pulled out of the birth canal remain in the birth canal for long.
● Flat head syndrome;this is where an infant keeps their head in same position whenever they sleep.
● Inherited diseases that cause problems with the muscles and nervous system.
● Certain medication or drug
SIGNS AND SYMPTOMS
The most apparent sign of wryneck or loxia is the twisting or tilting of the neck toward one side of the body. Both infants and adults with
wryneck, may experience the following;
➢ Painful, tensed neck muscle
➢ Neck cramps or burning sensation in the neck
➢ An unwillingness to turn or bend their head to the opposite side
➢ Eyes looking up without control
➢ Back pain
➢ Headaches
➢ Jerky muscle spasm in head and neck movements
➢ scoliosis
Infants with wryneck may show the following symptoms;
● Tilting of head to one side
● Flattening on one side of the head behind the ear
● A small, soft lump in the neck
● Breastfed babies favoring one breast over the other
● Musculoskeletal problems such as scoliosis or hip dysplasia
DIAGNOSIS OF TORTICOLLIS
Torticollis is diagnosed by doctors through physical examination and by asking questions about family history. They may also inquire about any
current medication the patient is taking. Further investigations would be made through precription of x-rays and ct-scan to know whether there is any fracture(#), or dislocation that may be causing the problem.
PHYSIOTHERAPY MANAGEMENT OF WRYNECK.
★ Wryneck is mostly a muscular condition and rarely involves the skeleton. The most expertise in the treatment of musculoskeletal condition would include a physical therapist. Torticollis can be treated, but the earlier the intervention of the physical therapist, the better the prognosis or treatment outcome.
★ Regardless of the patient’s age, physical therapy still remains the primary treatment for all forms of torticollis. A physical therapist provides treatment to address the impairment caused by the condition.The therapist will work with the child’s caregiver an adult patient to develop and reach mutual goals.
The therapist will design an individualized treatment plan to;
1. Strengthen neck muscles
2. Correct muscle inbalance
3. Gain pain-free movement(ROM)
4. Improve postural control and symmerty
5. Improves the body’s alignment by easing muscle tension
These goals may be achieved through; physio techniques to be applied
are indicated below:
● Gentle stretching of the neck muscle. The aim is to lengthen the shortened neck muscle for correct alignment.
● Strengthening of the neck muscles. This aimed to gain strength in the muscles opposite the side of the shortened muscles so that these muscles will inhibit the pull to balance the neck.
● Massage of the affected area. Massage by itself would not correct the deformity, but irritatant substances such as metabolites that are likely to cause pain would be dissolved due to improved blood circulation. The tensed muscles become relaxed as well.
● Neck Collar. This would keep the head as stable as possible
● Tapping to elongate the muscles to facilitate stretching of the antagonist(tight muscle)
● Ice packs would be preferred in acute situations
● Stretching exercises for the back pain and scoliosis if present.
Examples; Knee-chest,side planks,bridging,quadripled arm/leg raise,hamstring stretch, rod exercises and wall bar hang for the scoliosis
● Hot packs or hydrocollator packs could be used to soften the soft tissues for smooth gentle passive stretch and also aids in pain
relief.
● A home based-exercise program to continue gentle rehabilitation at home. The therapist should educate the caretaker on the treatment plan to be continued in the home.
SPONSORED BY:
BOAKYE SAMUEL
ODAME KUSI
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