What’s going on with your neck?
You’ve had a minor cold for the past few days, so you don’t feel your best. When you woke up this morning, your neck was stiff and painful. Also, you can’t turn your head to the right. Concerned that something serious might be going on, you go to the doctor. After examining you, she says that you have torticollis. What does this mean? Will it go away? How can you prevent it from coming back?
Definition
Torticollis (or wryneck) is a painfully twisted and tilted neck, causing the top of the head to tilt to one side while the chin tilts to the other side. The term comes from two Latin words: tortus, which means twisted, and collum, which means neck. You have a long muscle on each side of your neck that runs from the back of your ear to your collarbone, called the sternocleidomastoid (SCM). When this becomes tight, it shortens, resulting in torticollis. The condition can be congenital (present at birth) or acquired, often the result of damage to the neck muscles or blood supply. However, most of the time, the cause is unknown; this is referred to as idiopathic torticollis.
There are several types. Temporary can be from swollen lymph nodes, an ear infection, a cold, or an injury to your head and neck that causes swelling. It usually disappears after one or two days. Fixed, or permanent torticollis, is usually due to a muscular or bone structure problem. Muscular torticollis is the most common type of fixed and results from scarring or tight muscles on one side of the neck. Congenital muscular torticollis is the most common type seen in babies. It occurs because the baby might have been cramped in the womb or in an abnormal position (ex. breech position). Also, if forceps or a vacuum device were used during delivery, they might have put pressure on the baby’s SCM. Klippel-Feil syndrome is a rare, congenital form and occurs when the bones in the baby’s neck form incorrectly, notably due to two neck vertebrae being fused together. Children born with this condition may have difficulty with hearing and vision. Another rare type is cervical dystonia (or spasmodic torticollis), which causes neck muscles to contract in spasms. If you have cervical dystonia, your head twists or turns painfully to one side. It may also tilt forward or backward. Cervical dystonia can happen to anyone but is usually diagnosed in women between 40 to 60. While it can go away without treatment, there’s a risk of recurrence.
Torticollis symptoms can begin slowly and may worsen over time. The most common signs include an inability to move your head normally, neck pain or stiffness, headache, having one shoulder higher than the other, swollen neck muscles, and tilting your chin to one side. Chronic torticollis can cause complications, like swollen neck muscles, neurological symptoms from compressed nerves, chronic pain, difficulty performing routine tasks, an inability to drive, difficulty socializing, isolation, and depression.
For children with congenital torticollis, the symptoms can include their head tilts to one side with their chin pointing to the opposite shoulder, their head doesn’t turn side to side or up and down easily, there’s a soft lump in their neck muscle, they prefer to look over their shoulder at you, their eyes don’t follow you because that would require turning their head, or they have trouble breastfeeding on one side or prefers to feed on one side only. Often, they work hard to turn toward you, struggle to turn their head, and become upset because the movement is challenging. Also, they might start getting a flat head on one side — or both sides — from lying in one position all the time. This is known as positional plagiocephaly.
Treatment
Torticollis caused by a minor injury or illness is likely temporary and treatable. The key is getting treatment quickly to keep it from getting worse. The primary focus is applying heat and massaging the muscle to help it loosen. Also, stretching exercises are great for this. Your doctor can provide you with some or might recommend that you see a physical therapist depending on the severity of your condition. Some other options include traction and neck braces.
When it comes to medications, muscle relaxants and pain relievers can help individuals with temporary torticollis. For those with a chronic form, medicines used to treat the tremors of Parkinson’s disease or botulinum toxin injections repeated every few months may be beneficial. Another option for those with long-term torticollis is surgery. Procedures can include fusing abnormal vertebrae, lengthening neck muscles, or cutting nerves or muscles. For the most severe cases of cervical dystonia, your doctor may suggest using deep brain stimulation to interrupt nerve signals.
For babies, there are different techniques you can try. A big one is to use your baby’s appetite as an incentive by offering the bottle or your breast in a way that gets them to turn away from the favored side. Also, use toys, especially those with sounds and lights, to force your baby to look both ways. It’s essential to get them to play with their hands and feet since this will help them build muscle strength. In addition, be sure to give them plenty of time on their tummy because it will help strengthen their back and neck muscles and keep the back of their head from flattening. You should aim for 15 minutes of tummy time four times a day. Similar to adults, your child’s doctor may want them to see a physical therapist so you can learn specific stretching exercises. It’s important to note that most babies improve within six months once diagnosed and stretching exercises are started. Very rarely, children will need surgery to lengthen the sternocleidomastoid muscle. If so, most doctors wait until the child is a preschooler to consider this option.
Prevention
Unfortunately, there isn’t a way to prevent torticollis from occurring. If you have the condition, the goal should be to prevent it from getting worse. If your type isn’t treatable, seek out a support group because it can be comforting to connect with others in a similar situation and reduce your risk of complications.
Torticollis can be incredibly painful. However, it’ll go away with time and the proper treatment in most cases. If you have any questions or concerns about torticollis, please speak with your doctor. If you would like more information, please visit John Hopkins’ Torticollis (Wryneck) page at https://www.hopkinsmedicine.org/health/conditions-and-diseases/torticollis-wryneck