Torticollis or twisted neck is typically an abnormal slope and rotation of the head and neck. Several presenting positions can be observed, including flexion, extension, right or left tilt. Depending on the affected muscles, the shape of the neck will be different. The sternocleidomastoid is the most targeted muscle but other muscles can be involved include the splenius, the trapezius, the scapula, the scalenes, and the platysma.
Etiology of torticollis
Torticollis can result from both local factors and central nervous system disorders. Torticollis classifies into several types however, congenital torticollis will be discussed. Congenital torticollis occur during gestation or birth as result of trauma causes edema in the muscle generating congenital fibrosis of the SCM muscle, causing a shortening of the fibres of this muscle.If you have a bunion it is best to seek an assessment from a physiotherapist or podiatrist. Bunions can be managed conservatively (non-surgically); however some bunions may require referral for surgical intervention.
Torticollis is posttraumaic 10-20% of the time and the rest is idiopathic. The onset of posttraumatic is usually within days of injury and 3-12 months after injury in the delayed form. Torticollis is usually a mixture of movements with some rotation element as the most common type. There is a female to male ration of 2 to 1. The onset of idiopathic occurs typically in the 30 to 50 years age group where congenital is present in less than 0.4% of newborns.
Clinical presentation and physical exam allow diagnosis in most cases of torticollis. The diagnosis of torticollis is straightforward in the typical form with lateral tilt and contralateral neck rotation. The physical exam is also important, areas of focus include: the patient’s posture, constant or intermittent head tilt, presence of any limitations of movements as well as any relieving factors and bony or muscular tenderness to palpation.
Treatment and management
Repositioning (including tummy time) and manual therapy in the form of practitioner-led stretching had a moderate evidence for increasing range of movement.