Torticollis

What Is Tortocollis?

Torticollis, once also known as wryneck, is a twisting of the neck that causes the head to rotate and tilt to one side. Some element of rotation is the common presentation. Rotational torticollis is the most common type, followed by laterocollis (tilted to the side), retrocollis (tilted to the back), and anterocollis (tilted forward) being the rarest type.

What Are Common Causes Of Torticollis?

Torticollis can be congenital or acquired.

Congenital torticollis: If your baby has the condition at birth, it’s called congenital muscular torticollis. That’s the most common type. Common causes of torticollis at birth are the way your baby was positioned in the womb before birth, abnormal development of the neck muscle, and trauma or damage to the muscle during birth. Congenital muscular torticollis is present in less than 0.4% of newborns.

During gestation or birth, trauma can occur that causes edema (swelling) in the muscle, which can generate congenital fibrosis of the sternocleidomastoid muscle, causing a shortening of the fibers of this muscle.

Acquired torticollis: When babies develop the condition after birth, this is called acquired torticollis. Acquired torticollis may be linked to other, more serious medical issues.

Acquired torticollis may be caused by irritation to the cervical ligaments from a viral infection, injury, or vigorous movement. Additional common causes may include sleeping in an awkward position, burn injury or other injury that causes heavy scarring and skin or muscle shrinkage, and neck muscle spasm.

Torticollis is posttraumatic 10 to 20% of the time; the remainder is idiopathic, meaning there is no identifiable cause. Posttraumatic cervical dystonia is a condition that causes the neck muscles to involuntarily contract, causing the baby’s head to twist, usually with the chin toward the shoulder. The onset is usually within days of injury and 3 to 12 months after injury in the delayed form.

What Are The Symptoms Of Torticollis?

Each person may experience symptoms differently, but common symptoms of torticollis are:

• Neck muscle pain or pain down the spine
• Neck muscle stiffness
• Swollen neck muscles
• Inability to turn the head, with a head tilt to one side
• Spasm of the neck muscles
• Head tremors
• Awkward position of the chin
• Uneven shoulder height
• Headaches

What Are Types Of Torticollis?

There are eight general types of torticollis:

• Spasmodic torticollis (dystonia): this is the most common cause of neck rigidity.  This type of torticollis results from increased muscle tone. The most common triggering factors include emotional stress, physical overload, or sudden movement.
• Laterocollis is the second most common cervical dystonia.  The head is pulled to one side and down to the shoulder. Sometimes one shoulder lifts up.
• Anterocollis is when the chin is pulled down towards the chest. Both sternocleidomastoid and scalene muscles in the neck, which are responsible for rotation of the head to the opposite side and flexion of the neck, are often involved. This may cause problems with swallowing, speaking, socializing, and vision.
• Retrocollis is when the head is pulled backwards towards the spine. The muscles usually involved are the neck extensors. Communication, vision, and swallowing may be affected.
• Dermatogenic torticollis occurs when there is an injury to the skin of the neck and it shortens. This can lead to a limitation in movement.
• Ocular torticollis refers to the paralysis of muscles involved with the inclination and rotation of the head (compensation) from the involvement of the oblique extraocular muscles which control eye movements.
• Torcicolo vestibular torticollis involves the labyrinth of the inner ear and may affect balance.
• Neurogenic tormentor results from any neurological disorder or accident, such as stroke or trauma.

What Are The Treatment Options For Torticollis?

Treatment options for torticollis in children depend on whether the birth injury is congenital or acquired.

Congenital Muscular Torticollis

A child with congenital muscular torticollis should begin a program of physical therapy designed to lengthen the shortened SCM muscle.

Physical therapy programs will include specific exercises you can do at home on a set schedule, such as during diaper changes. In addition, you will learn how to hold your baby and tailor his/her environment to encourage him/her to turn his/her head and stretch the SCM muscle.

Your child’s physical therapist may recommend using a simple device called a “TOT collar.” TOT stands for Tubular Orthosis for Torticollis, which is a small piece of plastic tubing that fits around your baby’s neck. The TOT collar is designed to help babies straighten their heads and strengthen their neck muscles. Your physical therapist will teach you the proper way to use a TOT collar.

Children with torticollis with asymmetry of the face and head, known as plagiocephaly, often respond very well to non-surgical, minimally invasive interventions like:

• Customized, corrective helmets and molding cups
• Sleep position changes
• Special exercises

Sometimes other measures, such as surgery, are required to correct the shortened SCM muscle in torticollis and any asymmetry that may happen with plagiocephaly.

Acquired Torticollis

Treatment options will vary based on the cause of the torticollis. Some common therapies include:

nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain and discomfort related to musculoskeletal injury
antibiotic therapy for children whose torticollis is caused by infection
medications to stop gastroesophageal reflux for children whose primary cause of torticollis is reflux

What Are The Complications Of Torticollis?

When congenital muscular torticollis has not been effectively treated in the early stage, facial deformity in the child will appear after two years old. The main manifestations are facial asymmetry, asymmetric distance from bilateral external ocular angle to mouth angle, shortened distance from the affected side, and increased healthy side.

Complications of torticollis include:

• Visual fatigue and vision loss because the position plane of the affected eye is lowered, and both eyes are not on the same horizontal line.
• The healthy side of the face is round and full, while the affected side is narrow and flat.
• Compensatory scoliosis deformity (curvature) can occur in the cervical spine.
• The child’s entire face, including nose and ears, can also have asymmetric changes.
• Shoulder movement can also be limited.

When doctors fail to diagnose and or treat torticollis the condition can become permanent and sometimes worsen.

Why You Need An Experienced Torticollis Attorney

An experienced torticollis attorney is needed to identify those limitations that are caused by injury to the muscles or nerves during birth, resulting in torticollis. If the torticollis was caused by error during labor, the most common defense against a birth injury claim is that it was caused by position in the womb and not the doctor. Likewise, the failure to diagnose and treat torticollis at the earliest possible time may serve as a basis for a claim. Without an experienced NJ torticollis lawyer from the Britcher, Leone & Sergio law firm, it is difficult to win compensation for the baby.