Congenital muscular
torticollis
The etiology of congenital muscular torticollis is unclear.
Birth trauma or intrauterine malposition is also considered to cause damage to
the sternocleidomastoid muscle in the neck.[citation needed] This results in a shortening or excessive
contraction of the sternocleidomastoid muscle, often with limited range of
motion in both rotation and lateral bending. The head is typically tilted in
lateral bending toward the affected muscle and rotated toward the opposite
side. The condition may be caused by scars, disease of cervical vertebrae,
adenitis, tonsillitis, rheumatism, enlarged cervical glands, retropharyngeal
abscess, or cerebellar tumors. It may be spasmodic (clonic) or permanent
(tonic). The latter type may be due to Pott's Disease (tuberculosis of the
spine).
The
reported incidence of congenital torticollis is 0.3-2.0 %.[1] Sometimes a mass (a sternocleidomastoid tumor) in the affected
muscle may be noted, this appears at the age of two to four weeks, it
disappears gradually, but sometimes the muscle becomes fibrotic. It is likely
to disappear within the first five to eight months of life.
The
condition is treated initially with physical therapy, with stretching to
correct the tightness, strengthening exercises to achieve muscular balance,
handling to stimulate symmetry. A TOT Collar is sometimes used. About 5–10%
require "surgical release" of the muscle if stretching fails.[2][3]
Infants
with torticollis have a higher risk for plagiocephaly. Altering the head position and using a pillow
when supine helps as does giving a lot of tummy time when awake.
Other
less common causes such as tumors, infections, ophthalmologic problems and
other abnormalities should be ruled out. For example, ocular torticollis due to
cranial nerve IV palsy should not be treated with physical therapy. In this
situation, the torticollis is a neurologic adaptation designed to maintain
binocularity. Treatment should be targeted at the extraocular muscle imbalance.
In
general, if torticollis is not corrected facial asymmetry can develop.[citation needed] Head position should be corrected before
adulthood (to about the age of 18 there can be improvement). Younger children
show the best results.
Congenital
torticollis develops in the infant but can be diagnosed at older ages, even in
adults who were missed as infants/children.
The
word torticollis means wry neck: Acquired torticollis is not the same as
congenital torticollis. All ages can suffer from acquired torticollis.
1.
Low-impact exercise to
increase strong form neck stability
3.
Extended heat
application.
4.
Repetitive shiatsu
massage.
†An
Osteopathic Physician (D.O.) may choose to use Cranial techniques to
properly position the occipital condyles - thereby relieving compression of
cranial nerve XI in children with Torticollis. This is an example of Osteopathic
Manipulative Treatment.
Acquired torticollis
Acquired
torticollis occurs because of another problem and usually presents in
previously normal children and adults.
§
A self-limiting
spontaneously occurring form of torticollis with one or more painful neck
muscles is by far the most common ('stiff neck') and will pass spontaneously in
1–4 weeks. Usually the sternocleidomastoid muscle or the trapezius muscle is
involved. Sometimes draughts, colds or unusual postures are implicated; however
in many cases no clear cause is found. These episodes are rarely seen by
doctors other than a family physician.
§
Trauma to the neck can
cause atlantoaxial rotatory subluxation, in which the two vertebrae closest to the skull slide with
respect to each other, tearing stabilizing ligaments; this condition is treated
with traction to reduce the subluxation, followed by bracing or casting until
the ligamentous injury heals.
§
Tumors of the skull base
(posterior fossa tumors) can compress the nerve supply to the neck and cause
torticollis, and these problems must be treated surgically.
§
Infections in the
posterior pharynx can irritate the nerves supplying the neck
muscles and cause torticollis, and these infections may be treated with
antibiotics if they are not too severe, but could require surgical debridement in intractable cases.
§
Ear infections and
surgical removal of the adenoids can cause an entity known as Grisel's
syndrome, a subluxation of the
upper cervical joints, mostly the atlantoaxial joint, due to inflammatory
laxity of the ligaments caused by an infection. This bridge must either be
broken through manipulation of the neck, or surgically resected.
§
Antiemetics -
Neuroleptic Class - Phenothiazines
§
There are many other
rare causes of torticollis.
Spasmodic torticollis
Torticollis
with recurrent but transient contraction of the muscles of the neck and esp. of
the sternocleidomastoid. "intermittent torticollis . "cervical
dystonia"
TREATMENT:
Botulinus toxin has been used to inhibit the spastic contractions of the
affected muscles.
Diagnosis
Evaluation
of a child with torticollis begins with history taking to determine
circumstances surrounding birth and any possibility of trauma or associated
symptoms. Physical examination reveals decreased rotation and bending to the
side opposite from the affected muscle. Some say that congenital cases more
often involve the right side, but there is not complete agreement about this in
published studies. Evaluation should include a thorough neurologic examination,
and the possibility of associated conditions such as developmental dysplasia of the hip and clubfoot should be examined. Radiographs of the cervical spine should be
obtained to rule out obvious bony abnormality, and MRI should be considered if
there is concern about structural problems or other conditions.
Evaluation
by an ophthalmologist should be considered in children to ensure that the torticollis is
not caused by vision problems (IV cranial nerve palsy, nystagmus-associated "null position," etc.).
Most cases in infants respond well to physical therapy. Other causes should be
treated as noted above.
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