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.