10/09/2025
𝙏𝙤𝙧𝙩𝙞𝙘𝙤𝙡𝙡𝙞𝙨 (Wry Neck)
Torticollis, also known as wry neck, is a condition characterized by an abnormal, asymmetrical head or neck position due to sustained contraction or shortening of the sternocleidomastoid (SCM) muscle, or due to other neuromuscular, skeletal, or ocular causes. The term literally means “twisted neck.”
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𝙏𝙮𝙥𝙚𝙨 𝙤𝙛 𝙏𝙤𝙧𝙩𝙞𝙘𝙤𝙡𝙡𝙞𝙨
Torticollis can be classified broadly into:
1. Congenital Muscular Torticollis (CMT)
-Most common form in infants.
-Due to unilateral fibrosis/shortening of the SCM.
-Often associated with birth trauma, intrauterine malposition, or ischemic injury.
2. Acquired Torticollis
-May occur at any age, secondary to:
-Muscular causes – spasm or contracture of SCM, trapezius, or other cervical muscles.
-Skeletal causes – cervical spine anomalies, fractures, atlantoaxial rotatory subluxation.
-Neurological causes – dystonia, CNS lesions, syringomyelia.
-Ocular causes – ocular muscle imbalance (compensatory head tilt).
-Inflammatory/Infectious causes – retropharyngeal abscess, adenitis, tonsillitis.
-Drug-induced – acute dystonic reactions (e.g., to antipsychotics, metoclopramide).
3. Spasmodic Torticollis (Cervical Dystonia)
-A chronic neurological movement disorder.
-Involuntary intermittent or sustained contraction of neck muscles leading to abnormal postures and tremors.
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𝙋𝙖𝙩𝙝𝙤𝙥𝙝𝙮𝙨𝙞𝙤𝙡𝙤𝙜𝙮
1) Congenital muscular type: Fibrosis within SCM due to ischemic injury during labor → shortening → head tilt towards affected side and chin rotated to opposite side.
2) Acquired types: Imbalance in tone or control of cervical musculature caused by pain, trauma, infection, or CNS pathology.
3) Spasmodic type: Dysfunction in basal ganglia pathways leading to dystonia.
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𝘾𝙡𝙞𝙣𝙞𝙘𝙖𝙡 𝙁𝙚𝙖𝙩𝙪𝙧𝙚𝙨
1) Congenital Muscular Torticollis (CMT)
-Detected in infants (within 2–4 weeks of birth).
-Head tilt towards the affected SCM with chin rotated to the opposite side.
-Possible palpable SCM mass (“sternomastoid tumor”).
-Facial asymmetry (plagiocephaly) in untreated cases.
-Limited cervical range of motion.
2) Acquired Torticollis
-Sudden onset neck pain and stiffness.
-Restricted ROM due to spasm or guarding.
-Abnormal head position.
-Associated features depending on cause (fever, trauma, neurological symptoms, ocular issues).
3) Spasmodic Torticollis
-Gradual onset in adults (20–60 years).
-Involuntary spasms, jerks, or sustained abnormal head posture.
-May be painful.
-Psychological and social impact due to visible deformity.
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𝘿𝙞𝙛𝙛𝙚𝙧𝙚𝙣𝙩𝙞𝙖𝙡 𝘿𝙞𝙖𝙜𝙣𝙤𝙨𝙞𝙨
-Cervical spine fracture/dislocation.
-Atlantoaxial subluxation (Grisel’s syndrome).
-Posterior fossa tumors.
-Ocular palsy.
-Retropharyngeal abscess or cervical lymphadenitis.
-Dystonic reactions to drugs.
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𝙄𝙣𝙫𝙚𝙨𝙩𝙞𝙜𝙖𝙩𝙞𝙤𝙣𝙨
-Clinical examination (key for diagnosis).
-Ultrasound of SCM – in infants with suspected congenital muscular torticollis.
-X-ray cervical spine – to rule out bony abnormalities or subluxation.
-MRI brain/cervical spine – if neurological cause suspected.
-Blood tests – if infection/inflammation is suspected.
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𝙈𝙖𝙣𝙖𝙜𝙚𝙢𝙚𝙣𝙩
1. Congenital Muscular Torticollis
-Physiotherapy is the gold standard:
-Gentle passive stretching of SCM.
-Active range-of-motion exercises.
-Positioning therapy: encourage infant to turn head towards affected side.
-Tummy time and play-based facilitation.
-Parental education.
-Helmet therapy if plagiocephaly develops.
-Surgical intervention (SCM release/lengthening) if:
-Severe contracture persists beyond 1 year.
-No improvement after 6–12 months of physiotherapy.
2. Acquired Torticollis
-Identify and treat underlying cause:
-Analgesics, muscle relaxants, or anti-inflammatory drugs.
-Immobilization (short-term) if traumatic.
-Antibiotics/drainage for infectious causes.
-Ocular correction (glasses, surgery).
-Stop offending drugs in drug-induced dystonia.
•Physiotherapy:
-Heat therapy and TENS for pain/spasm relief.
-Gentle stretching of tight muscles.
-Strengthening of contralateral and weak neck muscles.
-Postural correction training.
3. Spasmodic Torticollis
•Medical:
-Botulinum toxin injections (first-line, gold standard).
-Anticholinergics, muscle relaxants, benzodiazepines.
•Surgical:
-Selective denervation or deep brain stimulation (DBS) in severe refractory cases.
•Physiotherapy:
-Gentle stretching and relaxation.
-Sensory tricks (“geste antagoniste” – touching face to reduce spasm).
-Balance and posture training.
-Stress management techniques.
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𝙋𝙧𝙤𝙜𝙣𝙤𝙨𝙞𝙨
-Congenital muscular torticollis: 90% cases resolve with physiotherapy if started early (
