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.