A Family Doctor's Tale - TORTICOLLIS

DOC I HAVE WRY NECK

Wry neck or torticollis  is common in many patients with poor postures especially when they do desk work or are driving in a car.

The patient usually complains of pain or stiffness of the neck muscles.

Neck movements are limited usually on one side.

Relaxation of the neck muscles can be done with physiotherapy such as traction and neck exercises or with muscle relaxant medicines or tranquillizers.


Torticollis or wry neck is a spasm of the sternomastoid, trapezius or other neck muscle causing pain in the neck and spasm in the neck muscle.


Every one can get Torticollis.
The age of onset is usually in the young people in the 20's except for congenital torticollis which appear in babies as early as 2 weeks from birth.


It is also more common in men than women.

The causes of Torticollis are:
1.Spasmodic torticollis - is usually a form of dystonia (abnormal tone) of the neck muscles


2.Trauma and injury of the neck muscle or deep cervical ligament such as whip lash injury can also indirectly injure the muscle and cause an acute wry neck.


3. Posture may also play a part in this condition especially ill fitting neck rest in cars or chairs or sleeping position

4.Congenital torticollis occurs as a swollen tender sternocleidomastoid muscle in a newborn baby appearing at the age of 2-4 weeks causing the neck to to be pulled to one side.

It may be due to birth trauma or abnormal position of the baby in the uterus.

Traction of the neck is usually done to stretch the swollen muscle.

It may disappear at the age of 5-8 months of age with treatment or spontaneously.

Very rarely is surgery required to release the contracted muscle.


Most torticollis cases presents with:

1.The onset is usually sudden with painful spasm of the neck muscles often without obvious precitating cause.


2.There may be a history of trauma to the neck or prolonged neck strain.


3.Movements of the head and neck is very painful and the head cannot be turned away from the affected side.


4.Neck movements may be restricted on the affected side.


5.Most cases are acute and wears off after a transitional period but may recur.


6.In spasmodic torticollis, there is sudden. usually short lived, with involuntary tipping or turning of head. Spasm may be prolonged in some cases.

Pain may be aggravated by stress, general health, prolonged period of the neck in one position.

An x-ray of the cervical spine can exclude degenerative cervical spondylosis.

Treatment involve:

1. application of warmth to the affected muscle


2.analgesic tablets especially muscle relaxant


3.analgesic cream


4.pain relieving sprays


5. soft neck support


6. Spasmodic torticollis tranquillizers like diazepam may help
to relieve the spasm


7.Rarely neurectomy may be required for severe cases of spasmodic torticollis.

Prognosis:
Acute wry neck usually resolves with treatment of underlying cause.
Spasmodic torticollis is usually more resistant to treatment.