This site and its Director were very helpful in getting answers and encouragement.
www.STclinic.com
S.T.R.C. TIPS
ST’rs have complex physical problems with varying degrees of involvement, so we custom the program to each individual person, according to their own situation and the way their ST manifests. For example, some clients can do almost all the exercises, some only a few; some can do the standing ones standing, others have to do those lying down to have the exercise be helpful and not be counterproductive. Re. the exercises, almost always the side to which your head turns is the "short side" (your muscles are more contracted on that side which pulls the head over and usually pulls that shoulder up.) You need to exercise to stretch both sides of the back (as ST almost always manifests also in the back) and neck with more emphasis on your short side. If you lean one direction and turn the other, you probably have a bilateral shortness and need to work both sides evenly. One of the keys is trying to stand erect, back of the neck flat, chin down, shoulders squared, and your head and neck stacked ontop of the trunk of your body, (i.e. a "military brace" position) not jutting out in front, which is so typical with ST'rs. You can see how this feels if you will lie down on the floor on your back, knees up. Now try to touch the floor with the back of your neck. You won't be able to, but try. You'll see that will force your chin way down. Now try to imitate that position standing up or sitting - that's the Military Brace position, and most exercises are done in that position. The chin should never be up with the head reared back. So if you are lifting a weight over your head, you can stand very straight in a military brace position (back of neck flat and chin down, shoulders squared), knees slightly bent and raise the weight over your head and down several times, maintaining the military brace. Think the exercise into the back of your head and neck - i.e. try to feel it there. You can begin with a 5 or 10 lb. bell or whatever is challenging for you. Then apply the same principal to other stretching exercises. The trick is to daily stretch those muscles and get them flexible and of equal length. Work in slow motion and hold the extension, breathing into it. Then you should be getting some daily massage - maybe from a family member. Sit in a chair sideways so your back is exposed, forearms on your knees, head hanging down, and have the person doing the back rub stand in back of you and use the heel of his hand (with some massage oil or hand cream) and begin at where the bra line would be for a woman and move up the muscles on either side of the spine and up into the neck, using as much pressure as is tolerable - to penetrate and stretch. Stay off the spine!! Never pinch the muscles. He can use his thumbs as well to work on the muscles in the back, across the shoulders and neck. The central area of irritation with ST appears to be in the muscles in the mid back, the upper shoulders and at the bony ridge at the back of the head, and you'll find you are probably very tender there. Because many people don't have someone at home who can massage them daily, we also recommend you buy a Kneading Fingers Machine. Currently priced at $211.96. Call 1-800-748-7172 and use STRC as a reference for this discount price, or order online at http://www.clarkenterprises2000.com/2079 for the same discount price. Also available with a 220/240 volt adapter. Sit in a firm recliner or wing back type chair. Put the machine behind your neck at the bony ridge, scoot your bottom forward, and lean hard into the machine, chin down. After a few minutes, lean slightly forward - the machine will slide a bit down your back; then massage that area for a few minutes, let it move a bit further down and so on until you have done the entire upper back. Don't use it lying down, because your head will want to roll back. This should be done DAILY! As you begin the exercises, it's almost a given that things will get worse for awhile-more spasms and more discomfort - as your body fights back -unfortunately that's predictable - just hang in there, but baby step your way into an exercise program. Be conservative, so that your body can get used to the changes gradually. You eventually adjust. It's a process and takes time - sometimes months for the body to adapt and begin to straighten out. You may have to begin very gently. Don't shock your body. What you are doing over time in this recovery program at S.T.R.C. is creating a new reality for your body - new muscle memory, new brain pathways, restructuring musculature and postural realignment, so that, eventually, that new reality, or new you, will begin to dominate, forcing the symptoms of S.T. into dormancy, and you can come into what we call a state of ongoing recovery. I personally have not seen a medical professional regarding my S.T. since 1983 and walk in recovery via this program.Don't sleep on a contour pillow!!! That will make the ST immediately worse. Feather is best as you can mold it, bunch it up. Sleeping on your back is best with the pillow under your head (more than under your neck), so that your chin is down and you're getting a nice passive stretch all night. DON'T sleep on your short side!!! It will make your ST immediately worse. It's OK to use a heating pad, but not for more than 30 minutes or so, as it will weaken the muscles, but for short periods of time it's fine. Because the way we sleep is so important and can effect our necks and our recovery progress, it’s important to, not only sleep on your back, chin tucked, but to sleep on a bed that is helping, not hurting. Personally I recovered on a full motion heated waterbed and still use one, but we are all different so choose a bed that's best for you. If you get chilly during sleep your body will curl up and it will be next to impossible to stay on your back. You can solve that problem by using a heated mattress pad or heated blanket. This is a different kind of heat than a heating pad and so is not only acceptable but needed if you are having trouble staying on your back.
And it's not advisable to use a cervical collar (unless you are using it as a holder for an iced gel pack or temporarily to be comfortable while driving, eating out, etc.), as collars will eventually weaken the neck. You can buy gel collars that you can use either hot or cold. Both are helpful - alternate hot and cold and end with cold. The ice packs will actually do more to relieve the pain and calm down the spasms, and I recommend keeping the sore areas iced for long periods of time. The best ice pack I’ve found is the Gel Cold Cervical Wrap (product #66102) - I love this product and strongly recommend it! It’s a flexible cold pack that covers the neck, top of shoulders and dips down the back. Put it in the freezer for 2 hours and then enjoy relief from both spasms and pain. To order go to http://www.therapyzone.com or call 1-800-822-2889 to order. This company also sells the Hang-ups Inversion Table. This table is safe and easily allows you to hang upside down for a full body traction. Do not leave small children unattended near the table. You should not use this table if you have high blood pressure, glaucoma or are on Artane.I also recommend long hot baths - it's important to let your body rest and relax. You should avoid like the plague doing anything that causes your head to jut forward or to have your chin up and head rolled back. Contact ST/Dystonia, Inc. 1-888-445-4588 if you want to order an Obusforme. They are wonderful portable chairbacks (get the highback one!) that you can put anywhere. VERY helpful in keeping you erect. Avoid recliners where you lay way back. They will make you worse. However, it took me a year or so to wean myself away from the recliner. These things have to be done in stages. Much better to be down on the floor with your head on a pillow, chin down if you want to rest, and be sure to program many short rest breaks into each day. That is also a good position for reading. (If you wear bifocals, put them on upside down!) Ditto for watching TV - lie on the floor, so you are not tempted to slouch or twist. Try not to cross your legs or twist your body when you sit. You can't possibly do it all right overnight since you have ST - but this is the idea, and you can begin to work toward this. Take it one baby step at a time. We like Shaklee vitamins because they are food based, not chemically based. I'm not a distributor, but you can find one in your area. We give the Shaklee Basics (including the Vita Lea, B, C, E with Selenium) and Calcium/Magnesium. Shaklee is by far the best product out there in my opinion. Also, it's very important to avoid sugar, much alcohol (especially red wine, as it tends to be a muscle inflammatory), caffeine and white flour products, junk food and preservatives, and NO sugar substitutes!!! Some clients are using granulated fructose, but NO aspartame! The very BEST sweetener is Xylitol (crystal form) - available in some health food stores (that will be the best price) or search online for the best price. Xylitol tastes like sugar but is actually is good for you - it helps prevent tooth decay and reduces plaque, fights osteoporosis as it builds bone density and fights ear infections in children. It has 40% fewer calories than sugar, is safe for diabetics and has 70% fewer carbs. - a natural product made from vegetable fiber and the bark of various trees. GREAT choice for all sweet needs! I get mine at http://www,emeraldforestxylitol.com The next best choice would be granulated fructose, available in bulk in almost all health food stores. Try to keep your diet as healthy as you can with plenty of raw fruits and veggies and lots of water. As a chiropractic neurologist once noted, if you smoke you cannot recover - period. there is something in smoke that mimics Acetylcholine, the chemical that travels from the brain into the muscles causing the spasms, so when you smoke, it's like inhaling Torticollis!!!
About all I could do when I began my own program was to hold a 10 lb. dumb bell and reach over as if to touch my toes and just hang with the head loose and released. And then slowly stand into a military and hang again. I'd do that for awhile and then lie down. 10 lbs. might be too much - so begin with maybe just 2 lbs. Begin very slowly and with little to no weight. Avoid doing things that really increase the pull WHILE you are doing them. The vitamins gave me increased strength and over the months I was able to move into more vigorous workout and eventually into weight work at the gym. Actually getting into recovery takes incredible commitment and hard work as you are totally reprogramming the body. The daily massage work is essential, and be positive. If you are saying things like "Oh, I know I'll never improve" - that easily can become a self-fulfilling prophecy. Then pray! I hope this will help. Let me know how you're getting along. We also offer the entire clinic program as an At-Home, long-distance course. Call us for details and an order form. 1-800-805-9976 or go to http://www.RecoveryClinic.org (site for long distance course only)God bless you, Abigail Brown, Director S.T.R.C.Clinic Web site http://www.STclinic.com
Thursday, August 28, 2008
Torticollis- Causes and Treatments
Torticollis, Neck Spasms, and Similar DisordersInflammation. "Wry neck" spasm (tonic, rarely clonic) of the sternocleidomastoideus and trapezius may be due to irritation of the spinal accessory nerve or other cervical nerves by swollen glands, abscess, acute upper respiratory infections, scar, or tumor. A spontaneous subluxation of the atlas may follow severe throat infection (eg, pharyngitis). Neck rigidity may also be the result of a sterile meningitis from blood in the cerebrospinal fluid. Thus, if a patient has slight fever, rapid pulse, and rigid neck muscles, subarachnoid hemorrhage should be suspected. Lateralizing signs are often indefinite.Congenital, Neuropathic, and Idiopathic Forms. The congenital form of torticollis is commonly associated with Klippel-Feil syndrome, atlanto-occipital fusion, and pterygium colli. Focal neuropathic causes include ocular dysfunctions, syringomyelia, and tumors of the spinal cord or brain. Idiopathic forms are seen in acute calcification of a cervical disc, rheumatic arthritis, tuberculosis, or "nervous" individuals. Nelson feels that wry neck may also be the result of subdiaphragmatic or subclinical visceral irritation being mediated reflexly into the trapezius and cervical muscles.Subluxation-Induced Torticollis. This common syndrome will be described in a subsequent paper.General Management. The muscles are rigid and tender, the head tilts toward the spastic sternocleidomastoideus, and the chin is rotated to the contralateral side. The priority is to locate and relieve causative or contributing subluxation complexes or other points of focal irritation. After the acute stage, isotonic exercises are useful in improving circulation and inducing the stretch reflex, especially in the cervical extensors. These exercises should be done supine to reduce exteroceptive influences on the central nervous system.Peripheral inhibitory afferent impulses can be generated to partially close the presynaptic gate by acupressure, acu-aids, acupuncture, or transcutaneous nerve stimulation. Most authorities feel deep sustained manual pressure on trigger points is the best method, but a few others prefer severe short-duration pressure (1 2 sec). Deep pressure is contraindicated in any patient receiving anti-inflammatory drugs (eg, cortisone) as subcutaneous hemorrhage may result. The effects of cervical traction are often dramatic but sometimes short lived if a herniated disc is involved. In chronic cases, relaxation training with biofeedback is helpful.It should not be overlooked that a metabolic disturbance may be the cause. For example, an acid-base imbalance from muscle hypoxia and acidosis is frequently a etiologic factor. It may be prevented by Lindahl s alkalization mixture (potassium citrate, 33.5%; calcium lactate, 41%; sodium citrate, 12%; magnesium glyconate, 12%; lithium citrate, 1.5%).Posttraumatic Exercise for Neck Soft TissuesAllman recommends a two-phase approach: the first limited to active exercise; the second, to resisted exercise. He advises that the exercise of Phase 1 should not begin until pain fades and that progress to more strenuous exercise should not be allowed during Phase 1. Phase 2 exercises should only begin when pain and stiffness have disappeared, and this phase includes Phase 1 exercises with resistance progressively added.Phase 1 Mode includes (1) active head rotation to the right and left, (2) active lateral flexion toward the shoulder bilaterally with the shoulders held erect, (3) active forward thrust of the neck with the chin forward and downward in an attempt to touch the lower thorax, and (4) active backward motion but not past the neutral position. Allman believes that hyperextension will aggravate most neck problems.Phase 2 Mode includes (1) partner resisting motion (with hands) in all planes of movement, (2) self-applied resistance with a towel or the patient s hands, and (3) movement against a spring-loaded or weight-loaded head strap.
Torticollis-Spasmodic Torticollis- Cervical Dystonia
Torticollis-Spasmodic Torticollis- Cervical Dystonia definition and answers.
Torticollis/Cervical Dystonia
Mission Statement
This website was created to be a starting point of information gathering. After seeing first hand how debilitating this condition can be, it was necessary to put everything I learned into cyberspace just in case someone else needed a place to start the search for treatment.
The information in this site comes from a lamen. After searching the internet for months day and night, I kept notes of the experience and the websites that gave information on this condition. The internet became one of the best sources of information since most doctors had very little knowledge of this condition or its cause.
Torticollis is scary and painful, but before you give up my advice is to fight. See different doctors, do not just take the opinion of one.
Do your research and do not take anything at face value. ( When researching take time to find out where the information is coming from)
Ask questions and get answers. If your doctor does not want to answer your questions or help examine you thoroughly—see another doctor.
Torticollis as defined by:
E-medicine
Background: Torticollis (from the Latin torti, meaning twisted and collis, meaning neck) refers to presentation of the neck in a twisted or bent position. Torticollis manifests in involuntary contractions of the neck muscles, leading to abnormal postures and movements of the head. Idiopathic spasmodic torticollis (IST) is considered a focal dystonia.
Pathophysiology: Torticollis is a symptom, as well as a disease, and it has a host of underlying pathologies. Torticollis can be divided into 2 types: congenital and acquired.
Congenital torticollis usually is not encountered in the ED, but it is worthy of mention because of its presentation. Infants born with torticollis appear healthy at delivery, but over days to weeks, they develop soft-tissue swelling over an injured sternocleidomastoid. Injury may be due to birth trauma or intrauterine malpositioning. This mass, which may be confused with a cystic hygroma or branchial cleft cyst, regresses and leaves a fibrous band in place of the sternocleidomastoid muscle, causing contracture of the neck.
Acquired torticollis has an identical presentation, but it has a host of underlying pathologies that must be excluded before diagnosis of IST can be made.
An acute form of torticollis, known as acute wryneck, is the type most frequently encountered in the ED. Acute torticollis develops overnight in young and middle-aged adults. Patients present with painful neck spasms. On examination, cervical muscle spasm is visible and palpable. Symptoms usually resolve spontaneously within 2 weeks. Treatment is symptomatic and consists of the use of heat, massage, supportive cervical collar, muscle relaxants, and analgesics.
IST is classified in a broad category of dystonic states, as a type of focal dystonia (ie, dystonic movements in a single body part). Torticollis may be associated with other forms of focal dystonia, such as blepharospasm, writer's cramp, spasmodic dysphonia, or orobuccal dystonia. Patients may present with tonic head deviation, clonic head movements, or both. Head deviation can be subdivided into lateral tilt or torsion. Patterns are not fixed and may change over time. The operational definition of IST contains the following elements:
Acquired, nontraumatic origin
Adult or childhood onset
Clonic and/or tonic involuntary contractions of multiple neck muscles
Sustained head torsion and/or tilt
Duration of 6 months or longer
Often associated with postural limb tremor
No history of chronic neuroleptic treatment
No associated ataxia, weakness, spasticity, or reflex changes
Normal brain CT scan
Frequency:
In the US: The exact incidence of IST is unknown, but it is thought to be about 3 per 10,000 individuals.
Mortality/Morbidity: Stress and emotional events may exacerbate symptoms of torticollis.
Persistent neck deviation occasionally elicits avoidance behaviors.
Considerable somatic and psychological disability may accompany chronic torticollis.
Sex: IST affects women more often than men, with a 4.5:1 ratio.
Age: IST may occur in children or adults. In 90% of cases, however, symptom onset occurs in patients aged 31-60 years.
As defined by MERCK:
Spasmodic torticollis (cervical dystonia) is a disorder characterized by painful intermittent or continuous contractions or spasms of the neck muscles, forcing the head to rotate or tilt forward, backward, or sideways.
Spasmodic torticollis, a form of dystonia, is diagnosed in 3 of 10,000 people in the United States and is about 1½ times more common among women than among men. The disorder can occur at any age but usually develops between the ages of 25 and 55.
Usually, the cause is unknown. Dysfunction within the basal ganglia (collections of nerve cells located at the base of the cerebrum, deep within the brain) may be the cause. Sometimes spasmodic torticollis is caused by injury to the neck muscles during pregnancy or during a difficult delivery. This type of spasmodic torticollis is called congenital torticollis. Imbalanced eye muscles and bone or muscle deformities of the upper spine can cause torticollis in children.
Symptoms and Diagnosis
Initially, symptoms may be mild, but they may become severe. They include involuntary turning of the head, muscle pains, and slight tremor of the neck muscles. Usually, only one side of the neck is affected. The direction in which the head tilts and rotates depends on which neck muscles are affected. Sharp, painful neck muscle spasms may start suddenly and occur intermittently or continuously. The spasms occur without warning but rarely during sleep. One third of people who have this disorder also have spasms in other areas, usually in the eyelids, face, jaw, or hand.
To diagnose the disorder in children and adults, doctors ask detailed questions about past injuries and other neck problems. During a physical examination of a newborn, doctors can detect neck muscle damage that may cause congenital torticollis.
Imaging procedures, such as x-rays, computed tomography (CT), and magnetic resonance imaging (MRI), are sometimes used to look for specific causes of neck muscle spasms, although such causes are not commonly identified.
Treatment and Prognosis
When a cause, such as bone or muscle deformities, is identified, torticollis can usually be treated successfully. However, when the cause is unknown, treatment is less likely to control the spasms. Sometimes the spasm can be temporarily relieved by physical and occupational therapy, which may include biofeedback, electrical stimulation, massage, cold packs and heat.
Course of Torticollis
From time to time you will remember tension from one side of the neck. It will slowly increase until turning your head takes noticeable effort. This may take months or even years. One morning you wake up and you can not move your head out of a locked position. The muscles have contracted and are not releasing.
When this happens, try not to panic. You want to find out why this occurred. Many publications and post can give no reason for why this condition occurs, but most of the time the events leading up to the manifestation of Torticollis are not examined.
Causes:
Prolapsed Cervical Disc
Prolapsed disc material may press on the dura resulting in neck pain and stiffness or the nerve root causing pain and paraesthesia in one or both arms
Incidence:
Male : Female 1.4:1
Aetiology:
Associated with heavy lifting and smoking
Clinically:
Onset usually not related to severe strain and often occurs on stretching upon wakingPain often radiates to the scapular region and sometimes the occiputRadicular pain (brachialgia) to one (rarely both) arms in the distribution of innervation of involved segmentThe neck may be tilted (torticollis), tender spots are palpated in the cervical musculature (trapezius and scapular region)Some movements are restricted and painful but at least one movement is full and painless in all but the most severe casesMay be weakness of muscle groups innervated by the affected rootForaminal compression test often positive and abduction / external rotation of the arm without changing neck position relieves the pain (hand behind the head)The commonest level is above or below the sixth cervical vertebrae involving the C6 or C7 rootsUpper limb movements are full
X-Rays
Loss of normal cervical lordosisDisc space is often narrowed
Differential diagnosis:
Cervical rib syndrome involving C8/T1 rootsCarpal tunnel syndrome where neck movements are painlessSupraspinatus tendon lesions or other shoulder pathologyTumours of the cervical spine or region may present with radicular symptomsCervical spine infection Neuralgic Amyotrophy where pain is sudden and severe with multiple levels involved
Pathogenesis:
Degenerate or traumatic tear of the annular fibres allowing prolapse of the intervertebral disc material
Treatment:
Rest, analgesics and anti-inflammatories (80 - 90% resolve)A soft cervical collar may be useful in the short term to improve comfortCervical traction may also provide relief of symptoms and provide comfort while the condition resolves (should not exceed 10lbs which is the approximate weight of the head)If symptoms severe and refractory operative decompression may be indicated via an anterior approach with subsequent stabilization of the cervical spine with a bone graft +/- internal fixation
Questions to ask yourself:
Was there a fall that could have injured your spine?
Were you in an accident that could have caused whiplash and you never noticed any serious pain. Have you ever had any spinal problems like scoliosis or slight fractures of the vertebrae? Have you ever been diagnosed with any type of joint disorder?
Test that you should think about getting:
MRI= Magnetic Resonance Imaging
Definition
A MRI is also called magnetic resonance imaging. It is an imaging method used by radiologists to view internal body structures using combinations of radio waves and magnetic fields. An MRI is a large noninvasive device which utilizes the properties of magnetism to create nondestructive, three-dimensional, internal images of the soft tissues of the body, including the brain, spinal cord and muscle.
CAT Scan= Computed Axial Tomography (CAT) Scan
Definition
Computed tomography (CT) a method of body imaging in which a thin x-ray beam rotates around the patient. Small detectors measure the amount of x-rays that make it through the patient or particular area of interest.
A computer analyzes the data to construct a cross-sectional image. These images can be stored, viewed on a monitor, or printed on film. In addition, three-dimensional models of organs can be created by stacking the individual images, or "slices."
XRAY=
Definition
X-ray studies are used to evaluate the skeleton (bones of the body) and it’s supporting structures. Fractures, problems involving the joints, and supporting structures within the joints can often be seen on an X-ray. Organs such as the chest, abdomen, and pelvis, can also be evaluated with X-rays. Specifically, X-rays can show abnormalities like tumors, masses, strictures, or obstructions. Certain diseases, such as pneumonia and tuberculosis, can also be identified on an X-ray.
Blood Test
Blood tests are a very useful diagnostic tool. Blood is made up of several different kinds of cells and other compounds, including various salts and certain proteins. The liquid portion of the blood is called plasma. When blood clots outside the body, the blood cells and some of the proteins become solid. The remaining liquid is called serum, which can be used in chemical tests and in tests to find out how the immune system fights diseases.
Treatments:
The best advice that I can give is to get rest and try to minimize stress.
No matter what anyone tells you try to relax and let your body rebuild and repair. Consider doing stretches. (Do not over tax your body with stretching but talk to a physical therapist.)
Most Doctors will be perplexed about your symptoms but do not be alarmed. There are people out there like you facing the same condition.
Do not be afraid to reach out and speak with other people in groups or through websites like wemove.org .
Keep your wits about you and remember that it will get better.
Torticollis/Cervical Dystonia
Mission Statement
This website was created to be a starting point of information gathering. After seeing first hand how debilitating this condition can be, it was necessary to put everything I learned into cyberspace just in case someone else needed a place to start the search for treatment.
The information in this site comes from a lamen. After searching the internet for months day and night, I kept notes of the experience and the websites that gave information on this condition. The internet became one of the best sources of information since most doctors had very little knowledge of this condition or its cause.
Torticollis is scary and painful, but before you give up my advice is to fight. See different doctors, do not just take the opinion of one.
Do your research and do not take anything at face value. ( When researching take time to find out where the information is coming from)
Ask questions and get answers. If your doctor does not want to answer your questions or help examine you thoroughly—see another doctor.
Torticollis as defined by:
E-medicine
Background: Torticollis (from the Latin torti, meaning twisted and collis, meaning neck) refers to presentation of the neck in a twisted or bent position. Torticollis manifests in involuntary contractions of the neck muscles, leading to abnormal postures and movements of the head. Idiopathic spasmodic torticollis (IST) is considered a focal dystonia.
Pathophysiology: Torticollis is a symptom, as well as a disease, and it has a host of underlying pathologies. Torticollis can be divided into 2 types: congenital and acquired.
Congenital torticollis usually is not encountered in the ED, but it is worthy of mention because of its presentation. Infants born with torticollis appear healthy at delivery, but over days to weeks, they develop soft-tissue swelling over an injured sternocleidomastoid. Injury may be due to birth trauma or intrauterine malpositioning. This mass, which may be confused with a cystic hygroma or branchial cleft cyst, regresses and leaves a fibrous band in place of the sternocleidomastoid muscle, causing contracture of the neck.
Acquired torticollis has an identical presentation, but it has a host of underlying pathologies that must be excluded before diagnosis of IST can be made.
An acute form of torticollis, known as acute wryneck, is the type most frequently encountered in the ED. Acute torticollis develops overnight in young and middle-aged adults. Patients present with painful neck spasms. On examination, cervical muscle spasm is visible and palpable. Symptoms usually resolve spontaneously within 2 weeks. Treatment is symptomatic and consists of the use of heat, massage, supportive cervical collar, muscle relaxants, and analgesics.
IST is classified in a broad category of dystonic states, as a type of focal dystonia (ie, dystonic movements in a single body part). Torticollis may be associated with other forms of focal dystonia, such as blepharospasm, writer's cramp, spasmodic dysphonia, or orobuccal dystonia. Patients may present with tonic head deviation, clonic head movements, or both. Head deviation can be subdivided into lateral tilt or torsion. Patterns are not fixed and may change over time. The operational definition of IST contains the following elements:
Acquired, nontraumatic origin
Adult or childhood onset
Clonic and/or tonic involuntary contractions of multiple neck muscles
Sustained head torsion and/or tilt
Duration of 6 months or longer
Often associated with postural limb tremor
No history of chronic neuroleptic treatment
No associated ataxia, weakness, spasticity, or reflex changes
Normal brain CT scan
Frequency:
In the US: The exact incidence of IST is unknown, but it is thought to be about 3 per 10,000 individuals.
Mortality/Morbidity: Stress and emotional events may exacerbate symptoms of torticollis.
Persistent neck deviation occasionally elicits avoidance behaviors.
Considerable somatic and psychological disability may accompany chronic torticollis.
Sex: IST affects women more often than men, with a 4.5:1 ratio.
Age: IST may occur in children or adults. In 90% of cases, however, symptom onset occurs in patients aged 31-60 years.
As defined by MERCK:
Spasmodic torticollis (cervical dystonia) is a disorder characterized by painful intermittent or continuous contractions or spasms of the neck muscles, forcing the head to rotate or tilt forward, backward, or sideways.
Spasmodic torticollis, a form of dystonia, is diagnosed in 3 of 10,000 people in the United States and is about 1½ times more common among women than among men. The disorder can occur at any age but usually develops between the ages of 25 and 55.
Usually, the cause is unknown. Dysfunction within the basal ganglia (collections of nerve cells located at the base of the cerebrum, deep within the brain) may be the cause. Sometimes spasmodic torticollis is caused by injury to the neck muscles during pregnancy or during a difficult delivery. This type of spasmodic torticollis is called congenital torticollis. Imbalanced eye muscles and bone or muscle deformities of the upper spine can cause torticollis in children.
Symptoms and Diagnosis
Initially, symptoms may be mild, but they may become severe. They include involuntary turning of the head, muscle pains, and slight tremor of the neck muscles. Usually, only one side of the neck is affected. The direction in which the head tilts and rotates depends on which neck muscles are affected. Sharp, painful neck muscle spasms may start suddenly and occur intermittently or continuously. The spasms occur without warning but rarely during sleep. One third of people who have this disorder also have spasms in other areas, usually in the eyelids, face, jaw, or hand.
To diagnose the disorder in children and adults, doctors ask detailed questions about past injuries and other neck problems. During a physical examination of a newborn, doctors can detect neck muscle damage that may cause congenital torticollis.
Imaging procedures, such as x-rays, computed tomography (CT), and magnetic resonance imaging (MRI), are sometimes used to look for specific causes of neck muscle spasms, although such causes are not commonly identified.
Treatment and Prognosis
When a cause, such as bone or muscle deformities, is identified, torticollis can usually be treated successfully. However, when the cause is unknown, treatment is less likely to control the spasms. Sometimes the spasm can be temporarily relieved by physical and occupational therapy, which may include biofeedback, electrical stimulation, massage, cold packs and heat.
Course of Torticollis
From time to time you will remember tension from one side of the neck. It will slowly increase until turning your head takes noticeable effort. This may take months or even years. One morning you wake up and you can not move your head out of a locked position. The muscles have contracted and are not releasing.
When this happens, try not to panic. You want to find out why this occurred. Many publications and post can give no reason for why this condition occurs, but most of the time the events leading up to the manifestation of Torticollis are not examined.
Causes:
Prolapsed Cervical Disc
Prolapsed disc material may press on the dura resulting in neck pain and stiffness or the nerve root causing pain and paraesthesia in one or both arms
Incidence:
Male : Female 1.4:1
Aetiology:
Associated with heavy lifting and smoking
Clinically:
Onset usually not related to severe strain and often occurs on stretching upon wakingPain often radiates to the scapular region and sometimes the occiputRadicular pain (brachialgia) to one (rarely both) arms in the distribution of innervation of involved segmentThe neck may be tilted (torticollis), tender spots are palpated in the cervical musculature (trapezius and scapular region)Some movements are restricted and painful but at least one movement is full and painless in all but the most severe casesMay be weakness of muscle groups innervated by the affected rootForaminal compression test often positive and abduction / external rotation of the arm without changing neck position relieves the pain (hand behind the head)The commonest level is above or below the sixth cervical vertebrae involving the C6 or C7 rootsUpper limb movements are full
X-Rays
Loss of normal cervical lordosisDisc space is often narrowed
Differential diagnosis:
Cervical rib syndrome involving C8/T1 rootsCarpal tunnel syndrome where neck movements are painlessSupraspinatus tendon lesions or other shoulder pathologyTumours of the cervical spine or region may present with radicular symptomsCervical spine infection Neuralgic Amyotrophy where pain is sudden and severe with multiple levels involved
Pathogenesis:
Degenerate or traumatic tear of the annular fibres allowing prolapse of the intervertebral disc material
Treatment:
Rest, analgesics and anti-inflammatories (80 - 90% resolve)A soft cervical collar may be useful in the short term to improve comfortCervical traction may also provide relief of symptoms and provide comfort while the condition resolves (should not exceed 10lbs which is the approximate weight of the head)If symptoms severe and refractory operative decompression may be indicated via an anterior approach with subsequent stabilization of the cervical spine with a bone graft +/- internal fixation
Questions to ask yourself:
Was there a fall that could have injured your spine?
Were you in an accident that could have caused whiplash and you never noticed any serious pain. Have you ever had any spinal problems like scoliosis or slight fractures of the vertebrae? Have you ever been diagnosed with any type of joint disorder?
Test that you should think about getting:
MRI= Magnetic Resonance Imaging
Definition
A MRI is also called magnetic resonance imaging. It is an imaging method used by radiologists to view internal body structures using combinations of radio waves and magnetic fields. An MRI is a large noninvasive device which utilizes the properties of magnetism to create nondestructive, three-dimensional, internal images of the soft tissues of the body, including the brain, spinal cord and muscle.
CAT Scan= Computed Axial Tomography (CAT) Scan
Definition
Computed tomography (CT) a method of body imaging in which a thin x-ray beam rotates around the patient. Small detectors measure the amount of x-rays that make it through the patient or particular area of interest.
A computer analyzes the data to construct a cross-sectional image. These images can be stored, viewed on a monitor, or printed on film. In addition, three-dimensional models of organs can be created by stacking the individual images, or "slices."
XRAY=
Definition
X-ray studies are used to evaluate the skeleton (bones of the body) and it’s supporting structures. Fractures, problems involving the joints, and supporting structures within the joints can often be seen on an X-ray. Organs such as the chest, abdomen, and pelvis, can also be evaluated with X-rays. Specifically, X-rays can show abnormalities like tumors, masses, strictures, or obstructions. Certain diseases, such as pneumonia and tuberculosis, can also be identified on an X-ray.
Blood Test
Blood tests are a very useful diagnostic tool. Blood is made up of several different kinds of cells and other compounds, including various salts and certain proteins. The liquid portion of the blood is called plasma. When blood clots outside the body, the blood cells and some of the proteins become solid. The remaining liquid is called serum, which can be used in chemical tests and in tests to find out how the immune system fights diseases.
Treatments:
The best advice that I can give is to get rest and try to minimize stress.
No matter what anyone tells you try to relax and let your body rebuild and repair. Consider doing stretches. (Do not over tax your body with stretching but talk to a physical therapist.)
Most Doctors will be perplexed about your symptoms but do not be alarmed. There are people out there like you facing the same condition.
Do not be afraid to reach out and speak with other people in groups or through websites like wemove.org .
Keep your wits about you and remember that it will get better.
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