Torticollis

• Torticollis:

  • Can be congenital or acquired - more commonly acquired
  • Called wry neck
  • Painful condition thought to be due to minor local musculoskeletal irritation causing pain and spasm in neck muscles
• Risk factors:

  • Age 40-60
  • Occupations associated with poor posture
  • Female
  • Stress, anxiety, depression and sleep disorders
  • Smoking
  • Obesity
  • Rheumatological disease
• Causes:

  • Poor posture
  • Trauma - may be very subtle and even unnoticed
  • Dystonia - rare and often idiopathic e.g. due to antipsychotics
• Presentation:

  • Sudden onset, severe unilateral pain - may be described as cramp or spasm
  • Pain may be referred to head or shoulder
  • Restricted and painful neck movements
  • Diffuse tenderness on affected side
• Investigations:

  • Not normally necessary - only needed if in doubt about diagnosis and want to rule out other causes e.g. rheumatological disease
• Management:

  • Give patient information
  • Apply heat or cold packs
  • Sleep on low firm pillow
  • Perform gentle neck flexibility exercises - neck rotation, neck stretch
  • Analgesia - paracetamol, NSAIDs, codeine depending on severity of pain and patient factors e.g. renal function
  • Consider physiotherapy
  • Safety net to return if not improvement
• Advise to not:

  • Use cervical collar as this limits movement and the outcome is improved with movement
  • Drive or ride a bike
• Prognosis:

  • Usually eases within 48 hours
  • Usually resolves within 7-10 days