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- Torticollis is a spectrum of disorders characterized by head tilt with rotation or involuntary movement.
- Pediatric disorders include:
- Congenital muscular torticollis (CMT): 80% of all infants presenting with torticollis are found to have CMT. CMT is seen at birth or early infancy and results from unilateral fibrosis and shortening of the sternocleidomastoid (SCM) muscle.
- Acquired torticollis
- Adult disorders include:
- Acquired torticollis (also known as wryneck), which is usually self-limited
- Spasmodic torticollis, also known as cervical dystonia, is caused by recurrent involuntary muscular contractions.
- Other forms (oculogyric, gastroesophageal reflux, arthritis-related, scoliosis-related, and hysterical torticollis) are not discussed.
- System(s) affected: Musculoskeletal; Nervous.
- Synonym(s): Acute wryneck; Idiopathic generalized torticollis; SCM torticollis; Neonatal torticollis; Idiopathic cervical dystonia; Focal dystonia; Nuchal dystonia.
- ~90% of cases occur in individuals aged 31–60.
- Predominant age: CMT: Newborn and infants; pediatric acquired torticollis, <10 years; adult acquired torticollis, 30–60 years; spasmodic torticollis, 30–50 years (mean age 40–43) (1)
- Predominant sex: Spasmodic torticollis, Female > Male (1.6:1); congenital muscular, Male > Female (3:2) (2)
Congenital: Up to 1/250 births (2); spasmodic, estimated at 1/100,000; overall incidence for torticollis is 24/1 million persons.
All focal dystonias combined: 295/1 million persons; no reliable data for pediatric and adult acquired torticollis
- CMT: Intrauterine crowding, breech position, ischemia, birth injury
- Pediatric acquired torticollis: Soft-tissue inflammation or infection, neurologic conditions, visual disturbances, trauma
- Adult acquired torticollis: Stress, unusual positioning (particularly when sleeping), exposure to cold drafts of air, medications, trauma, infection
- Spasmodic: Family history of dystonia, soft-tissue inflammation or infection, neurologic conditions, visual disturbances, trauma
Some forms may have genetic basis, such as spasmodic torticollis (1).
- Intrauterine malpositioning may lead to trauma of the SCM and fibrosis.
- Birth trauma, such as a clavicular fracture
- Pediatric acquired torticollis: Pain, spasm, decreased range of motion without trauma
- Adult acquired torticollis:
- Emotional stress, postural factors (e.g., work, sleep, lying while reading or watching TV, prolonged unusual positioning of neck), or exposure to cold; many cases are idiopathic
- Medication reactions (e.g., amphetamines, haloperidol, chlorpromazine, ketamine)
- Spasmodic torticollis:
- Muscular damage from inflammatory or infectious diseases
- Cervical spine injuries and spondylosis
- Ocular disorders
- Organic CNS disorders
- Vestibular dysfunction
Congenital: Associated with birth injury that, without treatment, becomes a fibrous cord and may be associated with persistent craniofacial deformities.
Commonly Associated Conditions
- >80% of infants with CMT also present with craniofacial asymmetry, deformational plagiocephaly of varying degrees, and developmental hip dysplasia.
- Congenital and pediatric acquired torticollis: Consider Klippel-Feil syndrome (congenital fusion of cervical vertebrae).
- Pediatric and adult acquired torticollis: Spinal abnormalities
- Spasmodic torticollis: Treatment of psychiatric disorders