Torticollis or commonly known as wry neck, is a stiffening of the neck muscles that causes lateral contracture along the cervical spine. The main causes of the condition are muscle spasms that cause the lateral flexion contracture of the muscle groups supplied by the spinal accessory nerve. As a result, the neck appears twisted with the head turned to one side and the chin pointing to the opposite side. Torticollis can be experienced both by adults and children.

What are the Causes of Torticollis?

Torticollis can be caused by various factors. Congenital torticollis or torticollis at birth as seen in new born babies is usually a result of wrong positioning of the fetus inside the womb, which caused damage to the sternocleidomastoid muscle or the nerves along the cervical spine. It can also be caused by trauma at birth especially when the head and neck passes along the birth canal.

Acquired torticollis or those that develop in previously normal individuals are caused by the following factors:

  • Trauma to the neck

Any trauma to the neck can possibly lead to nerve damage, which subsequently causes the muscles to become spasmodic.

  • Tumors along the base of the skull

Any tumor present at the base of the skull may compress the spinal accessory nerve leading to torticollis.

  • Ear infections

Ear infections can predispose the development of Grisel’s syndrome. This is a condition that involves subluxation along the joints in the cervical spine leading to wry neck.

  • Surgical removal of the adenoids

History of adenoid removal can also cause similar effects of ear infections.

  • Pharyngeal infections

Any infection in the posterior pharynx can also cause irritation of the spinal accessory nerve leading to a twisted neck.

  • Use of antipsychotic drugs

Antipsychotics or neuroleptics have a common side-effect of torticollis making psychiatric patients suffer from painful and twisted neck.

What are the Symptoms of Torticollis?

Aside from the twisted neck, torticollis may also produce the following symptoms:

  • Headache
  • Pain in the neck
  • Tremors on the head
  • Limited range of motion of the neck joint
  • Asymmetrical shoulders (one shoulder is higher than the other)
  • Neck muscle swelling and tenderness

More severe cases of torticollis may even cause the head to entirely turn to one side. CT- scans, MRIs and electromyography are usually used to determine the area of affectation and whether other underlying conditions such as brain tumors are present.

How do you Manage Torticollis?

Torticollis is more severe than a ‘stiff neck’ because it tends to last longer and the symptoms are more severe and debilitating. Managements include both conservative and aggressive managements depending on the root cause of wry neck. Common treatment modalities include:

  • Heat application and massage therapy. These managements are employed for symptomatic relief of pain.
  • Stretching exercises. Stretching the neck muscles helps relieve muscle spasms and makes the muscle groups along the cervical spine more flexible.
  • Use of neck braces. Braces are commonly used to reduce the lateral contracture of the neck.
  • Medications. Anti-spasmodic and anticholinergic drugs are used to reduce muscle rigidity and promote relaxation of the neck muscles. Botulinum toxin injections are also used to paralyze the affected nerves to reduce pain and spasticity.
  • Surgery. Compression of the spinal accessory nerve usually needs surgery to relieve pressure on the nerves supplying the neck.
  • Chiropractic care. Chiropractic care is also the treatment of choice for cervical spine subluxations. Manipulations are done to restore the proper alignment of the cervical spine to relieve pressure on the nerves.

To prevent possible complications such as further nervous system affectation, torticollis should be managed earlier.