Torticollis
Infant with
torticollis since birthAxial CT without contrast of the cervical spine shows the C1 vertebral body rotated to the left approximately 45 degrees in relation to the C2 vertebral body.The diagnosis was atlanto-axial rotatory subluxation without a demonstrated etiology.
Torticollis (wryneck) is a clinical finding of head tilt with or without rotational spinal malalignment. It is not a diagnosis in itself and there are a wide range of underlying conditions. It is most common in the pediatric age group.
Pathology
Torticollis can be acute (<1 week) or chronic (>1 week), and may be congenital or acquired. In chronic torticollis, up to 20% may be due to non-muscular conditions (e.g. skeletal abnormalities) .
Etiology
There is a wide range of causes of torticollis and the presence of associated symptoms/signs is important in narrowing the possible causes. Below is a non-comprehensive list of the more common causes.
Congenital
- musculoskeletal
- congenital muscular torticollis, congenital absence of sternocleidomastoid muscle
- atlantooccipital or cervical vertebral fusion, hemivertebrae
- ligamentous laxity: seen in Down syndrome, achondroplasia, etc.
- CNS
- syringomyelia
- ocular abnormalities, e.g. congenital strabismus/nystagmus
Acquired
- idiopathic
- musculoskeletal
- trauma: fracture, facet joint dislocation, muscle spasm
- fibromatosis colli
- osteomyelitis
- juvenile rheumatoid arthritis
- ligamentous laxity: as above plus Grisel syndrome
- head and neck
- CNS
- drug side effect
- acute dystonias including torticollis are recognized extrapyramidal side effects seen with antipsychotic medications
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