Torticollis Wry Neck or Loxia

Torticollis refers to a condition in which the sternocleidomastoid muscle is shorter (and sometimes tighter) on one side of the neck, causing the head to tilt toward the shortened muscle, while at the same time the chin rotates in the opposite direction. This condition (also known as wry neck or loxia) can be observed at all ages, from newborn children to adults, and it can be acquired congenitally or postnatally.

The word “torticollis” has its roots in the Latin term “tortus” which means twisted, and “collum” which means neck. It was first defined by an orthopedic surgeon Alfred Herbert Tubby in the year 1912 as a congenital or acquired deformity with lateral inclining of the head to shoulder along with neck torsion and face deviation.

Today, a new classification of torticollis is primarily based on the pathogenesis and dynamic qualities of the condition. All cases of torticollis can be classified as either nonparoxysmal/nondynamic (congenital muscular torticollis, osseous torticollis, ocular torticollis and those with nonmuscular etiology) or paroxysmal/dynamic (cervical dystonia, benign paroxysmal torticollis, Sandifer syndrome, increased intracranial pressure and those caused by various drugs).

Causes and Symptoms

Congenital muscular torticollis represents a painless condition that arises as a result of one-sided shortening of the sternocleidomastoid muscle and usually presents in infancy. This condition can stem from damage to the aforementioned muscle that occurs due to birth trauma or hampered muscle development.

Torticollis can also be caused by certain underlying genetic conditions, sometimes associated with other disorders in infancy (one example is a developmental dysplasia of the hip). In rare instances, torticollis is caused by the abnormalities of the cervical spine or by superior oblique palsy (also known as a fourth nerve palsy).

Spasmodic torticollis is a rare condition that usually affects middle-aged women, and it is produced by abnormal contractions of the cervical muscles with subsequent rotatory movements of the head. Such dystonic muscle spasms that are seen in cases of spasmodic torticollis may have an effect on any combination of neck muscles.

Chronic torticollis may result in tingling and numbness in the neck, muscle swelling from underlying tensions, as well as with other symptoms related to the nervous system. There is also a growing clinical evidence that the dysfunction of a temporomandibular joint may be a co-factor in this neurological and painful disorder.

Diagnosis and Treatment

Congenital muscular torticollis is usually evident by approximately four months, which is the age when infants slowly gain head control (albeit severe cases can already be noticeable in newborns). It must be emphasized that without any treatment, congenital torticollis can result in changes in the shape of the child’s head, eating problems and uneven facial features.

Certain tests may be pursued in order to diagnose torticollis, including CT (computed tomography) scan of the neck, EMG (electromyogram) to ascertain which head and neck muscles are most affected by measuring the electrical activity in the muscles, but also MRI (magnetic resonance imaging) of the neck and brain.

Treatment for torticollis depends on the underlying cause. For example, the treatment for congenital muscular torticollis focuses on stretching the shortened muscles in the neck by a series of exercises known as passive stretching and positioning. This approach is most effective if it is introduced before the age of three months, but in more severe cases surgery represents the treatment of choice.

Depending on the cause, the treatment for acquired torticollis includes stretching exercises in order to prevent muscle spasms, a neck brace and specific medications. To relieve pain caused by this condition, heat or massage therapy are also used. Cervical traction is an approach that employs mechanical force to put tension on a muscle.

Spasmodic torticollis may resolve without any treatment, although symptoms sometimes have a tendency to reappear. Injections of a Botulinum toxin-A (popular Botox) into the affected muscles can substantially reduce signs and symptoms of spasmodic torticollis, but with an increased risk of dysphagia (difficulty swallowing) and dry mouth. Surgery is sometimes needed as well.