Torticollis, also known as wry neck, is a clinical finding of head tilt with or without rotational spinal malalignment. It is not a diagnosis in itself and there are a wide range of underlying conditions. It is most common in the pediatric age group.
Pathology
Torticollis can be acute (<1 week) or chronic (>1 week), and may be congenital or acquired. In chronic torticollis, up to 20% may be due to non-muscular conditions (e.g. skeletal abnormalities) 2.
Etiology
There is a wide range of causes of torticollis and the presence of associated symptoms/signs is important in narrowing the possible causes. Below is a non-comprehensive list of the more common causes.
Congenital
- musculoskeletal
- congenital muscular torticollis, congenital absence of sternocleidomastoid muscle
- atlantooccipital or cervical vertebral fusion, hemivertebrae
- ligamentous laxity: seen in Down syndrome, achondroplasia, etc.
- CNS
- syringomyelia
- ocular abnormalities, e.g. congenital strabismus/nystagmus
Acquired
- idiopathic
- musculoskeletal
- trauma: fracture, facet joint dislocation, muscle spasm
- fibromatosis colli
- osteomyelitis
- juvenile rheumatoid arthritis
- ligamentous laxity: as above plus Grisel syndrome
- head and neck
- CNS
- drug side effect
- acute dystonias including torticollis are recognized extrapyramidal side effects seen with antipsychotic medications
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