Acute Torticollis/Wry neck

• Acute Torticollis / Wry neck - pathology/anatomy:

  • thought to be due to irritation of local musculoskeletal tissues around the neck - leads to spasms in the neck muscles and restricted ROM
  • Unilateral neck pain, previously thought to be due to disc or intra-articular entrapment of menisci or synovial tissue
  • specific cause is unknown, but could be due to being in a specific posture for prolonged periods of time, sleeping in awkward positions or carrying something heavy - anything that can change the load through the cervical spine
  • Usually occurs between C2 to C4 but can occur at any level

  
• Acute Torticollis / Wry neck - clinical presentation:

  • History/Subjective – Often report unguarded movement leading to sharp unilateral neck pain and muscle spasm, more common in females, more common in children than adults
  • Discogenic wry neck more gradual onset affecting the lower cervical spine and older pts
  • Objective - Restricted ROM in the cervical spine, avoiding movement towards symptoms, often hold cervical spine in lateral flexion away from pain, muscle spasm often present, pts may hold neck away from side of pain
  • Key impairments: pain and restricted range of movement

  
• Acute Torticollis / Wry neck - Management:

  • usually conservative, majority of symptoms resolve within 24 - 48 hours, but can last for longer (a week) and can return
  • Advice and education: re pathology, prognosis
  • Symptom control: Analgesics, NSAIDS, relaxation techniques for soft tissue, heat, ice
  • Build capacity: ROM exercises away from pain - symptoms usually high severity, low irritability, so pts exercise within comfort
  • Manual therapy – PAIVMS in easing position
  • Exercise ? Non-weightbearing
  • Return to function
• Acute Torticollis / Wry neck - Management:

  • Be aware of other types of torticollis:
  • Congenital - affecting young boys, contracture of the sternocleidomastoid due to a tumour or ischaemia of the muscle
  • Traumatic - follows subluxation of the C1/C2 joints, often in children
  • Spasmodic – rare but due to focal dystonia