Types of torticollis
Congenital muscular torticollis is associated with shortening and fibrosis of the sternocleidomastoid muscle and usually becomes noticeable in the first weeks of life. Positional torticollis develops when a child constantly lies with his head turned to one side: the muscle is not changed, but the usual position and flattening of the occiput is formed. In children, the bone form also occurs with anomalies in the development of the cervical vertebrae. Acute torticollis in children and adults occurs suddenly after uncomfortable sleep or hypothermia and is associated with muscle spasm. Spasmodic torticollis in adults is a neurological disorder involving involuntary contractions of the neck muscles.
- Congenital muscular torticollis
- Positional torticollis
- Bone shape for vertebral anomalies
- Acute torticollis after sleep or hypothermia
- Spasmodic torticollis (cervical dystonia)
- Torticollis due to inflammatory processes in the neck
- Ocular torticollis with visual impairment
Muscular torticollis in infants
It is usually noticed in the first weeks: the child holds his head tilted to one shoulder, and his chin is turned in the opposite direction, while turning his head in one direction is limited. In the thickness of the muscle, a dense spindle-shaped compaction is sometimes felt, which gradually decreases. The danger lies not so much in the tilt itself, but in the consequences: a constant position of the head leads to flattening of the back of the head on one side and asymmetry of the face, as well as to the fact that the child develops symmetrical movements worse. Therefore, treatment begins as early as possible.
- Tilt of head to one shoulder
- Turning the chin in the opposite direction
- Limitation of head rotation to one side
- Lump in the neck muscle
- Flattening of the back of the head on one side
- Long-term facial asymmetry
Survey
A pediatric orthopedist assesses the range of head movements, palpates the neck muscles, examines the shape of the skull and face, and checks for concomitant hip dysplasia, which is often combined with torticollis. Ultrasound of the neck muscles shows the condition of the sternocleidomastoid muscle and helps to distinguish the muscular form from the positional one. An X-ray of the cervical spine is prescribed if a vertebral anomaly is suspected. If a child's head tilt appears suddenly, especially with pain, fever or after injury, an examination is carried out urgently, since the cause may be infection, trauma or neurological pathology.
- Examination with assessment of the range of head movements
- Palpation of the neck muscles
- Ultrasound of neck muscles
- Hip examination
- X-ray of the cervical spine according to indications
- Examination by a neurologist and ophthalmologist for unknown reasons
Treatment in children
The basis is positional therapy and regular stretching exercises for the affected muscle, which are taught to parents by a specialist. The point is to encourage turning the head in the “difficult” direction: shift the baby in the crib, change the side from which he is approached and fed, place toys and light sources so that he has to turn. Lying on your stomach during periods of wakefulness under supervision is very useful - it strengthens the neck muscles and relieves the back of the head. Massage and physiotherapy are prescribed by the doctor as an addition. If conservative treatment is ineffective over a long period of time and movement restrictions persist, surgical correction is considered.
- Stretching exercises taught by a specialist
- Positional therapy and changing positions in the crib
- Placing toys on the “difficult” side
- Laying on the stomach while awake
- Massage and physiotherapy as an addition
- Orthopedic devices prescribed by a doctor
- Surgery for persistent limitation of movements
Torticollis in adults
The most common situation is acute torticollis: a person wakes up with sharp pain and the inability to turn his head. This is a muscle spasm that goes away within a few days; Warmth, gentle movements as tolerated, and painkillers as needed help, but complete immobility slows down recovery. Spasmodic torticollis is a different condition: involuntary muscle contractions cause persistent turning or tilting of the head, trembling, pain, and it does not go away on its own. The main method of treatment here has become botulinum therapy, supplemented by physical therapy and, if necessary, medications. Separately, it is necessary to exclude secondary causes: trauma, inflammation, side effects of certain medications.
- Acute torticollis after sleep goes away within a few days
- Warmth, gentle movements, painkillers if necessary
- Avoid complete neck immobility
- Spasmodic torticollis requires examination by a neurologist
- Botulinum therapy as the main method for dystonia
- Physical therapy and posture correction
- Rule out medicinal and secondary causes