TORTICOLLIS

Presented by: Catalua, Valerie Joy S.

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Wry Neck is a stiff neck associated with muscle spasm, classically causing lateral flexion contracture of the cervical spine musculature (a condition in which the head is tilted to one side). The muscles affected are principally those supplied by the spinal accessory nerve.

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Incidence 1 in every 250 neonates is born with congenital torticollis. 10 to 20 % of infants with torticollis have also a congenital hip dysplasia (improper formation and function of the hip socket.)

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Assessment Positional plagiocephaly (asymmetrical head shape) X-ray Electromyogram (EMG)

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Congenital Muscular or Sternomastoid Torticollis is a condition that occurs at birth or up to 2 months of age, where the childs head is tilted to one side. Etiology: Injury of sternocleidomastoid muscle during birth Injured blood supply of the fetus neck at birth Wrong position of fetus while inside the womb resulting to tightness of the sternocleidomastod muscle (muscle that connects the breastbone and the collarbone to the skull) Klippel-Fiel Syndrome (less common cause)

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Congenital Muscular or Sternomastoid Torticollis Symptoms: Painless Lump in the affected muscle (can be palpated or noticeable at about 1-2 months of age) Limited range of motion of the head Swelling of the neck muscles (possibly present at birth) Shoulder is higher on one side of the body Stiff neck muscles

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Acquired Torticollis occurs because of another problem and usually presents in previously normal children and adults. Etiology: Damage of the nervous system Damage of the muscles around the neck Tumors of the skull base (posterior fossa tumor) Pharyngitis (can irritate the nerves supplying the neck muscles and cause a wry neck) Use of antipsychotics (acute dystonia)

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Acquired Torticollis Symptoms: Painful neck Shoulder is higher on one side of the bosy Stiff neck muscles Head posture abnormality Head tremor Headache Shoulder is higher on one side of the body

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Acquired Torticollis The use of certain drugs, such as antipsychotics, can cause torticollis. Antiemetics - Neuroleptic Class Phenothiazines There are many other rare causes of torticollis.

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Spasmodic Torticollis is a chronic neurological movement disorder causing the neck to involuntarily turn to the left, right, upwards, and/or downwards

The condition is also referred to as "cervical dystonia". Both agonist and antagonist muscle contract simultaneously during dystonic movement.
Most patients first experience symptoms midlife

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Spasmodic Torticollis Signs and Symptoms: Initial symptoms of spasmodic torticollis are usually mild. The head may turn or tilt in jerky movements, or sustain a prolonged position involuntarily. Over time, the involuntary spasm of the neck muscles will increase in frequency and strength until it reaches a plateau. Symptoms can also worsen while the patient is walking or during periods of increased stress. Other symptoms include muscle hypertrophy, neck pain, dysarthria and tremor. Studies have shown that over 75% of patients report neck pain, and 33% to 40% experience tremor of the head.

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Spasmodic Torticollis Classifications of Spasmodic Torticollis Primary having no other abnormality other than dystonic movement and occasional tremor in the neck. it is usually inherited Secondary diagnosed when any of the following are present: history of exogenous insult of exposure, neurological abnormalities other than dystonia, abnormalities on brain imagining, particularly in the basal ganglia

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Spasmodic Torticollis Secondary A variety of conditions can cause brain injury, from external factors to diseases. Perinatal cerebral injury Kernicterus Cerebrovascular diseases Drug induced Central nervous system tumor Peripheral or central trauma Infectious or post infectious encephalopathies Toxins Metabolic Paraneoplastic syndromes Central pontine myelinolysis

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Spasmodic Torticollis Head Positions Torticollis is the horizontal turning (rotational collis) of the head, and uses the ipsilateral splenius, and contralateral sternocleidomastoid muscles. This is the "chin-to-shoulder" version. Laterocollis is the tilting of the head from side to side. This is the "ear-to-shoulder" version. This involves many more muscles: ipsilateral sternocleidomastoid, ipsilateral splenius, ipsilateral scalene complex, ipsilateral levator scapulae, and ipsilateral posterior paravertebrals.

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Spasmodic Torticollis Head Positions The flexion of the neck (head tilts forwards) is anterocollis. This is the "chin-to-chest" version and is the most difficult version to address. This movement utilizes the bilateral sternocleidomastoid, bilateral scalene complex, bilateral submental complex.

Retrocollis is the extension of the neck (head tilts back) and uses the following muscles for movement: bilateral splenius, bilateral upper trapezius, bilateral deep posterior paravertebrals. This is the "chin-in-theair" version.

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TREATMENT Stretching the shortened muscle Traction, heat, massage Botulinum toxin used to inhibit the spastic contractions of the affected muscles Give anticholinergics like Atropines Surgery

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MANAGEMENT Congenital Torticollis Passive stretching exercises and encouraging the infant to look at the affected muscle (by feeding at the direction of the affected area and positioning mobiles on the injured part). If simple exercises are not effective, a surgical correction is done. This is followed by usage of neck immobilizer to further correct the deformity.

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MANAGEMENT Acquired Torticollis Identification of underlying cause of the disorder. Heat application for head and neck pain Cervical spine traction Neck massage Anticholihergic drugs Use of Botulism (Botox)

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Stretching ang Positioning Stretching 1. For the following stretching exercises, the parent sits with the back against the wall and knees bent. 2. Place the child in your lap, with the child on her back and knees tucked.

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Stretching ang Positioning

Sidebending 1. Hold the childs RIGHT/LEFT shoulder down with your RIGHT/LEFT hand. 2. Place your RIGHT/LEFT hand on top of the RIGHT/LEFT side of the childs head, and slowly bend her head towards her LEFT/RIGHT shoulder. 3. Hold the position for 10 seconds. Repeat 15 times, 4 to 6 times a day.

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Stretching ang Positioning

Rotation 1. Place your RIGHT/LEFT forearm against the childs LEFT/RIGHT shoulder, and cup the childs head with the same hand. 2. Use your LEFT/RIGHT hand to hold the childs chin. 3. Slowly rotate the childs face to her RIGHT/LEFT. 4. Hold the position for 10 seconds. Repeat 15 times, 4 to 6 times a day.

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Stretching ang Positioning Positioning Playing on stomach: When the child is on her stomach, position all toys in the crib so that the child has to turn her face to the RIGHT/LEFT.

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Stretching ang Positioning Carrying 1. Hold the child facing away from you, in a side-lying position, with the childs RIGHT/LEFT ear resting against your RIGHT/LEFT forearm. 2. Place your LEFT/RIGHT arm between the childs legs and support the childs body. 3. Carry the child in this position as much as possible.