Torticollis Treatment in Singapore

• A limitation of motion of the cervical spine that causes the head to be held in a tilted position
• May result from muscular, skeletal, or neurologic abnormalities (Fig. 1)
• Classification :
  • Congenital abnormalities
  • Acquired abnormalities
• Synonyms: Skeletal wry neck; Congenital wry neck; Cock-robin deformity; Sandifer syndrome (torticollis resulting from gastroesophageal reflux disease and hiatal hernia)

• The most common cause is rotatory subluxation of the atlantoaxial joint, an acquired condition.
• Congenital muscular torticollis usually is evident in the first 6-8 weeks of life.
• Other causes may appear throughout childhood or may become evident well into adulthood.
• Males and females are affected equally.

• Local trauma to the infant’s neck during delivery, especially during a difficult delivery
• For atlantoaxial rotatory subluxation: Upper respiratory infection, pharyngitis, or trauma

• Congenital muscular torticollis is caused by contracture of the sternocleidomastoid muscle.
• Congenital bony torticollis may be secondary to occipitocervical abnormalities.
• Acquired torticollis may result from neurogenic, traumatic, inflammatory, or idiopathic causes (see Differential Diagnosis).
• Bony abnormalities: Atlanto-occipital synostosis, basilar impression, odontoid abnormalities, cervical hemivertebrae, or asymmetry of occipital condyles
• Atlantoaxial rotatory subluxation, the most common bony abnormality, is characterized by rotatory displacement of C1 on C2 and may be congenital or secondary to inflammation or trauma.

• Hallmark sign: Tilting of the head to 1 side with limitation of ROM
• Usually the patient rotates the head away from the neutral (straight) position, but not toward it.
• Patients may present with a neck mass (contracted sternocleidomastoid muscle).
• Neck pain is a common complaint, but it usually occurs in adults.
• Patients also may complain of occipital pain, vertigo, or dizziness aggravated by certain movements of the head.
• If torticollis persists beyond infancy, secondary asymmetry of the cranium (plagiocephaly) may remain.

Tests

• Neurogenic causes:
  • Spinal cord tumors of the cervical spine
  • Cerebellar tumors
  • Syringomyelia
  • Ocular dysfunction
• Traumatic causes:
  • Subluxations
  • Fractures and dislocations of the occipitocervical junction
• Inflammatory causes:
  • Cervical adenitis
  • Rheumatoid arthritis
• Idiopathic causes:
  • Atlantoaxial rotatory subluxation or displacement

• Congenital muscular torticollis:
  • Responds to stretching exercises in nearly 100% of patients treated before 1 year of age
  • Positioning of toys in the crib will encourage the child to stretch the involved side.
• Atlantoaxial rotatory subluxation:
  • Patients usually recover with physical therapy if the condition is detected within the 1st week of onset.
  • Use of a soft collar and analgesics is for patients with atlantoaxial rotatory subluxation patients.
  • Patients with recalcitrant cases may require muscle relaxants and a hard collar or brace.
  • If treatment is delayed, traction or even surgery is required.

Special Therapy

• Congenital muscular torticollis that is refractory to stretching may require release of the sternocleidomastoid muscle.
• Severe atlantoaxial rotatory subluxation or other severe bony abnormality may require fusion of C1 and C2.

• Fixed subluxation
• Plagiocephaly (in late-treated muscular torticollis)

• Neurologic status should be followed closely.
• Bony abnormalities, such as rotatory subluxation, may require repeated CT scans.

• Once the cause is known, anatomic models may be used to explain the cause of the torticollis to patients and families.
• Patients and families should be made aware of the usual course of the condition and the possible need for different methods of therapy.

FAQ