Torticollis (quick review)

21 Mar

submitted by Christina Brown, M.D. 

 

Definition – “Twisted neck” (L. tortus, twisted + collum, neck).29727

Synonyms: Cervical dystonia, wry neck

Self-limited, symptoms resolve in 1 to 2 weeks

Possible Etiologies:

  • Fracture
  • Dislocation, subluxation
  • Cervical spine disease
  • Infections
  • Spondylosis
  • Tumor
  • Scar tissue–producing injuries
  • Ligamentous laxity in atlantoaxial region
  • Drug induced
  • Otolaryngologic:
    • Vestibular dysfunction, Otitis media
    • Cervical adenitis, Pharyngitis, Retropharyngeal abscess
    • Mastoiditis
  • Esophageal reflux
  • Syrinx with spinal cord tumor

 

Physical Exam

  • Intermittent painful spasms of sternocleidomastoid (SCM), trapezius, and other neck muscles
  • Head is rotated and twisted to one direction

 

Management:

Imaging

  • 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

ED TREATMENT/PROCEDURES

  • Soft collar and rest,
  • Physical therapy,
  • Massage,
  • Local heat,
  • Analgesics

 

MEDICATION:

  • 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.

 

References:
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.

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