Summary about Disease
Wry neck, also known as torticollis, is a condition characterized by an abnormal, asymmetrical head or neck position. The head is often twisted to one side, and the chin points to the opposite side. It can be congenital (present at birth) or acquired later in life. The condition can involve muscle spasms, shortening of neck muscles (particularly the sternocleidomastoid), or underlying skeletal or neurological issues.
Symptoms
Head tilted to one side
Chin pointed to the opposite side
Limited range of motion in the neck
Neck stiffness or pain
Shoulder raised on the affected side
Headaches
Muscle spasms in the neck
In infants, a small, soft lump in the neck muscle (sternocleidomastoid)
Causes
Congenital Muscular Torticollis: Shortening or tightening of the sternocleidomastoid muscle, often due to positioning in the womb.
Acquired Torticollis:
Muscle strain or injury
Sleeping in an awkward position
Inflammation or infection
Medication side effects
Cervical spine abnormalities
Nervous system disorders (e.g., dystonia)
Tumors (rare)
Grisel's syndrome (atlantoaxial rotatory fixation secondary to upper respiratory infection or surgery)
Medicine Used
Pain relievers: Over-the-counter medications like ibuprofen or acetaminophen can help manage pain.
Muscle relaxants: Medications like cyclobenzaprine can help relieve muscle spasms.
Botulinum toxin (Botox): Injections into the affected neck muscles to reduce muscle contractions.
Other medications: Depending on the underlying cause, medications may be prescribed to treat infections, inflammation, or neurological conditions.
Topical medications: such as diclofenac
Is Communicable
No, wry neck is not communicable or contagious. It cannot be spread from person to person.
Precautions
Proper posture: Maintain good posture while sitting, standing, and sleeping.
Ergonomics: Ensure a comfortable and ergonomic workspace to prevent neck strain.
Stretching and exercise: Regularly perform neck stretches and exercises to maintain flexibility and strength.
Warm-up before exercise: Prepare your neck muscles before physical activity.
Avoid prolonged awkward positions: Refrain from holding the neck in uncomfortable positions for extended periods.
Prompt treatment: Seek medical attention for any neck pain or stiffness to prevent wry neck from developing.
How long does an outbreak last?
The duration of wry neck varies depending on the underlying cause and treatment.
Acute wry neck: (e.g., due to muscle strain) may resolve within a few days to a few weeks with rest, pain relief, and physical therapy.
Chronic wry neck: (e.g., due to dystonia or congenital torticollis) can persist for months or years and may require ongoing management.
Congenital torticollis: if treated early with physical therapy, can often be resolved within a few months.
How is it diagnosed?
Physical examination: A doctor will assess the range of motion in the neck, palpate the neck muscles, and observe posture.
Medical history: The doctor will inquire about symptoms, onset, and any potential causes.
Imaging tests:
X-rays: To evaluate the cervical spine for abnormalities.
MRI: To visualize soft tissues, including muscles, ligaments, and nerves.
CT scan: Provides detailed images of the bones and soft tissues.
Electromyography (EMG): To assess nerve and muscle function.
Timeline of Symptoms
The timeline of symptoms can vary significantly.
Congenital Torticollis: Noticeable at or shortly after birth.
Acute Torticollis: Symptoms develop suddenly, often after sleeping in an awkward position or experiencing a minor injury.
Gradual Onset: Symptoms worsen progressively over time, possibly due to underlying conditions.
Important Considerations
Early intervention: Early diagnosis and treatment are crucial, especially for congenital torticollis, to prevent long-term complications.
Physical therapy: Physical therapy is a mainstay of treatment, focusing on stretching and strengthening the neck muscles.
Underlying causes: It's essential to identify and address any underlying medical conditions contributing to wry neck.
Differential diagnosis: Wry neck can be a symptom of various conditions, so a thorough evaluation is necessary to rule out other potential causes.
Psychological impact: Chronic wry neck can have a significant impact on quality of life and may lead to anxiety or depression.
Infant positioning: "Back to sleep, tummy to play" is vital to avoid SIDS, however, infants with a head turning preference should be encouraged to turn their head to the non-preferred side during play and awake times.