An Overview of Torticollis

Physiotherapy on a woman's neck

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Torticollis is a medical term that describes a "wry" or "twisted" neck. There are two main types of torticollis—congenital (present at birth) and acquired (caused by trauma, infection, or a reaction to a medication, to name a few possibilities). The type of torticollis a person has will dictate their symptoms. For example, congenital torticollis in infants is generally painless, while acquired torticollis often causes neck pain and restricted neck movements.

Torticollis can be, but typically is not, a medical emergency. It can usually be diagnosed with a medical history and physical examination. Sometimes, imaging of the neck is warranted. Treatment of this condition may entail physical therapy, medication, and less commonly, surgery.

Causes

The potential causes of torticollis depend on the type.

Congenital Torticollis

Congenital torticollis occurs in approximately 0.3% to 1.9% of all live births and occurs as a result of the shortening of one of the sternocleidomastoid muscles (SCMs).

The SCM is a large muscle in the neck that connects the back of your skull to your breastbone (sternum) and clavicle (on either side)

While experts are not sure exactly why some babies are born with a single shortened SCM, they suspect it may be due to one or more of the following factors:

  • Crowding within the uterus during the pregnancy
  • Fibrosis of the muscle from bleeding and/or trauma during childbirth
  • Primary myopathy (muscle disease) of the SCM

Acquired Torticollis

Acquired torticollis usually occurs from inflammation or injury to the sternocleidomastoid or the trapezius (a muscle involved in shoulder and neck movements).

This muscle injury or inflammation most commonly results from trauma or from an infection of the throat or neck lymph nodes. Certain medications may also trigger torticollis, as can scar tissue or neck arthritis.

In addition, some adults have a condition called cervical dystonia (a.k.a. spasmodic torticollis) in which the neck muscles contract on their own. 

Rarely, there are other culprits behind a person's torticollis, like a tumor or bleeding in the cervical spine (neck).

Symptoms

Like the underlying causes, the symptoms of torticollis vary based on the type.

Congenital Torticollis

Congenital torticollis is a painless condition that causes infants to have their head tilted to one side and their chin pointed to the opposite side. For example, if their head is tilted to the right, their chin will be pointed to the left.

In addition to a head and chin tilt, babies with congenital torticollis may have a lump on the side of the neck that the head is tilted toward.

A face that appears asymmetrical is also often present with this type of torticollis.

Acquired Torticollis

Individuals with acquired torticollis usually report neck pain with certain neck movements, as well as a "locked" sensation after quickly rotating their neck. 

They may also report headaches, head tremors, and stiff or swollen neck muscles. One shoulder may also appear higher than the other. 

Other potential symptoms of torticollis in children and adults depend on the underlying cause.

For example, if an infection is the cause of the torticollis, a fever may be present.

With benign paroxysmal torticollis (a type of acquired torticollis in children), episodes of head tilting are associated with symptoms like vomiting, paleness, irritability, ataxia, or sleepiness.

With ocular torticollis (also a type of acquired torticollis in children), a child may tilt their head to the side to avoid double vision.

Finally, torticollis that occurs as a reaction to a medication, may be accompanied by tight jaw muscles and problems speaking.

When to See Immediate Medical Attention

It's important to note that most cases of torticollis are not life-threatening. That said, some symptoms indicate injury or irritation to the structures of the brain and/or spinal cord.

If you or your child are experiencing any of these symptoms, it's important to seek medical attention right away:

  • Difficulty breathing, speaking, or swallowing
  • Difficulty walking
  • Weakness, numbness, or pins and needles in your arms and legs
  • Incontinence (urinary or fecal)
  • Neck-muscle spasms and a fever
  • Swollen glands
  • Neck stiffness or swelling
  • Headache

Diagnosis

The diagnosis of torticollis begins with a thorough medical history.

Your doctor may ask you questions about when your symptoms started or whether there was an inciting injury or trauma. They will also likely inquire about medication exposures and associated symptoms (besides neck pain), such as fever, headache, or neurological problems.

Your doctor will then conducted a physical exam that is focused on your head and neck muscles and nervous system.

For trauma-induced or persistent torticollis (or for other indications), imaging tests— like an X-ray, computed tomography (CT) scan, or magnetic resonance imaging (MRI)—may be warranted.

Treatment

The treatment of congenital torticollis usually entails physical therapy to help stretch and straighten out a child's neck. Less commonly, surgery to lengthen or release the muscle may be needed.

The treatment of acquired torticollis is focused on treating the underlying cause (e.g., antibiotics for an infection) and easing symptoms.

To relieve neck pain and help relax the neck muscles, the following therapies may be recommended:

Botulinum toxin (Botox) injections can also be helpful, especially for spasmodic torticollis.

A Word From Verywell

Due to the complexity of this condition and the fact that treatment is often warranted, if you think that your child (or yourself) has torticollis, please seek out guidance from your doctor.

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