submitted by Christina Brown, M.D.
Definition – “Twisted neck” (L. tortus, twisted + collum, neck).
Synonyms: Cervical dystonia, wry neck
Self-limited, symptoms resolve in 1 to 2 weeks
- Dislocation, subluxation
- Cervical spine disease
- Scar tissue–producing injuries
- Ligamentous laxity in atlantoaxial region
- Drug induced
- Vestibular dysfunction, Otitis media
- Cervical adenitis, Pharyngitis, Retropharyngeal abscess
- Esophageal reflux
- Syrinx with spinal cord tumor
- Intermittent painful spasms of sternocleidomastoid (SCM), trapezius, and other neck muscles
- Head is rotated and twisted to one direction
- Plain film if cervical fracture is suspected.
- CT or MRI of cervical spine if retropharyngeal abscess or tumor suspected
INITIAL STABILIZATION/THERAPY: Cervical spine immobilization if fracture is suspected
- Soft collar and rest,
- Physical therapy,
- Local heat,
- Diphenhydramine (for drug-related dystonia)
- Valium: 2–5 mg IV, 2–10 mg PO t.i.d. (peds: 0.1–0.2 mg/kg per dose IV or PO q6h)
- Botulinum toxin is an option for treating non-drug-induced torticollis, though this is not typically administered in the ED setting.
1. Schaider, J. & Barkin, R. & Hayden, S. & Wolfe, R. & Barkin, A. & Shayne, P. & Rosen, P. (2011). Torticollis. Rosen’s and Barken’s 5-Minute Emergency Medicine Consult. http://www.r2library.com.proxy.its.virginia.edu/Resource/Title/1608316300/ch0020s16613
2. Harries PG. Retropharyngeal abscess and acute torticollis. J Laryngol Otol 1997; 111:1183.
3. Soundappan SV, Darwish B, Chaseling R. Traumatic spinal epidural hematoma-unusual cause of torticollis in a child. Pediatr Emerg Care 2005; 21:847.
4. Mutsaers P, Fick M, Plötz FB. Acquired torticollis as the only initially presenting symptom in a child with a brainstem glioma. Eur J Pediatr 2007; 166:1075.
5. Shanker V and Bressman S.: What’s new in dystonia? Curr Neurol Neurosci Rep. 2009; 9:278–284.