What Causes Torticollis?

Torticollis symptoms and signs include a head tilt toward one side and neck pain.

Torticollis, commonly known as a wry neck, is an abnormal twisting of the neck toward one side. Congenital torticollis is present from birth, and acquired torticollis can occur at any point later in life.

Congenital torticollis is caused when there is an abnormal rotation of the fetus in the mother's womb. It is likely to be associated with hip dislocation in the utero, as well. Other causes include the fusion of two vertebrae of the baby while he is in his mother's womb. This rare condition is known as Klippel-Feil syndrome, which can also be associated with vision and hearing problems in the baby. Congenital forms are a permanent type of torticollis and need correction by surgery.

Acquired torticollis can be caused by any of the following factors:

• Abnormal position of the neck while sleeping
• Trauma to the head or neck
• Dislocations or fractures of the cervical vertebrae
• Infections of the ear
• Extensive tissue damage due to burns
• Lymph node swelling
• Problems with the muscular system or nerves adjoining the neck
• Cervical spine tumors
• Cervical spondylitis (inflammation of the cervical spine)
• Reaction to medications:
  • Phenothiazines (class of medications used in psychiatry)
  • Metoclopramide (a medication commonly used to prevent vomiting)
  • Haloperidol (medication used in the treatment of psychiatric illnesses)
  • Carbamazepine (medication used in epilepsy treatment)
  • Phenytoin (medication used in epilepsy treatment)
  • L-dopa therapy (medication used in Parkinson's treatment)

Torticollis without a known cause is referred to as idiopathic spasmodic torticollis or cervical dystonia. It is most common in people 40-60 years of age. It affects women more than men.

The characteristic sign of torticollis is visible as twisting of the person's head toward any side: right, left, downward, or upward. Other signs and symptoms may differ among different individuals. They include the following:

• Stiffness of the neck
• Pain and difficulty in turning the neck
• Tilting of the chin
• Headache
• Swelling of the neck muscles
• Giddiness

In adults, torticollis can keep coming back even after it goes away after a few to several days. These are known as relapses of torticollis and are generally associated with cervical dystonia (spasms).

Doctors usually take your complete medical history and perform a physical examination to arrive at the diagnosis. To find out the cause, they may order the following additional tests:

• Imaging tests: X-ray and magnetic resonance imaging (MRI) can help diagnose structural problems with the bone and surrounding tissue.
• Electromyography (EMG): This is a procedure that measures the response of your muscle to stimulation of the nerves that control that particular muscle.

The temporary form of torticollis caused by events such as awkward sleeping positions and infections usually resolve within 1-2 weeks. It may go away on its own or need measures such as

• heat therapy,
• local massage,
• stretching exercises, and
• ultrasonic waves.

Other treatments include

• chiropractic pressure,
• neck collar,
• neck brace,
• traction,
• simple medications such as muscle relaxants and painkillers,
• medication used for treating Parkinson's disease, and
• botulinum toxin injections administered directly into the neck.

If there are structural problems in your cervical spine, your doctor may need to perform surgery depending upon the type of problem. The surgery may include any of the following:

• Surgery to separate the fused bones
• Surgery to cut the nerve that supplies the particular muscle
• Surgery to lengthen the muscle