What are the other Names for this Condition? (Also known as/Synonyms)

• Contracture of Neck
• Psychogenic Torticollis
• Wryneck

What is Acquired Torticollis? (Definition/Background Information)

• Torticollis is a muscular disorder that results in a twisted neck or a sideways tilted head, due to the neck muscles undergoing abnormal muscle contractions. It can be congenital or acquired
• Acquired Torticollis is thought to occur spontaneously due to some underlying physiological abnormality, injuries to the region, infections, certain debilitating tumors affecting nerves in the head, or other conditions resulting in damages to the neck muscles. When no cause can be attributed to the disorder, it is called Idiopathic Torticollis
• The muscular disorder may be temporary, or may last for a very long period. It is completely curable in most cases using therapy, exercises, and/or surgery

Who gets Acquired Torticollis? (Age and Sex Distribution)

• Acquired Torticollis may affect a child (age 1 and upwards), or an adult. It can develop during any period in an individual’s life
• Both male and female sexes are equally prone to this condition. There are no gender preferences

What are the Risk Factors for Acquired Torticollis? (Predisposing Factors)

Risk factors for Acquired Torticollis include:

• Neurological and/or muscular impairment due to tumor growth, affecting brain or spinal cord
• Morphological abnormalities of the central nervous system (spine or brain)
• Airway problems, throat inflammation leading to pus formation (abscess), or severe cold affecting the sinuses, ears (acute and chronic sinusitis)
• Infections of the spinal cord, neck, head, jaws, mouth, or even the scalp
• External traumatic injuries that affect the head or neck; or repeated abuse/overuse of the muscles located at that region
• Use of certain psychiatric medication; drugs used to control nausea
• Arthritic attack on the neck vertebrae
• Blood vessel or lymphatic system disorders
• Family history of the condition (rarely)

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Acquired Torticollis? (Etiology)

• The primary basis of Torticollis is a contraction or excessive shortening of the sternocleidomastoid muscle (SCM) located in the neck, leading to slanting of the head towards one side and limiting muscular motion range. This may occur due to a host of factors
• Many muscles may be involved in the abnormal bending and twisting process. Most of these muscles are controlled by the spinal accessory nerve; a nerve that controls head rotation, tilting, shoulder elevation, and backward bending of neck
• There are several explanations why this damage and muscle impairment might take place and these include: Abnormalities of the neck bones and damage to spinal cord; external injury and infections affecting the neck region; use of drugs, such as antipsychotics and antiemetics; tumors compressing nerves at the neck or base of skull

What are the Signs and Symptoms of Acquired Torticollis?

In some children or adults with Acquired Torticollis, the wry neck appearance may be mild and almost invisible. However, it may progressively worsen if left untreated. The following signs and symptoms may be observed:

• Head turned to any one side, tilted down at an angle; abnormal head posture with one shoulder slightly lifted (sometimes)
• Limited movement of the neck/head
• Pain that gradually affects the neck, shoulder, back, and chest
• Neck , shoulder muscle cramps and stiffness
• Sometimes, muscle tenderness and burning sensations are felt in the affected areas

How is Acquired Torticollis Diagnosed?

A simple physical examination may be conclusive enough to arrive at a Torticollis diagnosis. However, in order to determine the extent of the condition, and the type of muscles involved with Acquired Torticollis, certain diagnostic tests are performed. These include:

• Physical exam with evaluation of medical history
• X-ray of the neck (cervical spine assessment)
• Ultrasound scan of the neck
• Electromyogram; to assess nerve and muscle health
• MRI scan of the brain
• A thorough muscular and neurological system examination: This is done through a physical examination to assess ability to perform certain stretching and bending motions. Such movements help assess the condition of the nerve, and one’s motor skills
• Eye examination to rule out cranial nerve palsy and eye symptoms

What are the possible Complications of Acquired Torticollis?

Complications of Acquired Torticollis are mainly linked to the severity of the condition, and the presence of secondary medical disorders. These include:

• Inflammation and pain in the muscles, due to severe twisting and turning
• Nerve roots in the neck region could be affected, giving rise to neurological problems in the head and neck
• Recurrence of the condition after treatment and surgery (this is usually the case with Spasmodic Torticollis)

How is Acquired Torticollis Treated?

The treatment measures for Acquired Torticollis are basically meant to prevent worsening of the condition and correct the defect. The interventions could be surgical or non-surgical. Surgical methods are mainly used if the condition is classified as severe by the physician and do not improve after non-surgical procedures, which form the usual line of treatment. The management measures include:

• Physical therapy, to gently help increase the range of motion, to prevent further muscle contracture and loss of muscle function, using suitable stretching and musculoskeletal strengthening exercise program. This helps in decreasing muscle fatigue and stress
• Use of special neck collars, neck braces
• Application of warm compress, or heat
• The surgical techniques are employed if symptoms persist, even after conservative management of the condition. Surgery may involve cutting certain muscles and nerves that cause Torticollis. This is known as selective denervation surgery, which is then followed by post-surgical physiotherapy
• Botox injections may be used to improve muscle condition and strengthen the muscle tone. Botox may also help by decreasing further deterioration of the symptoms

How can Acquired Torticollis be Prevented?

• The causative factors dictate whether Acquired Torticollis is preventable or not. Though, in most cases it cannot be prevented
• Active research is currently being performed to explore the possibilities for treatment and prevention of inherited and acquired disorders such as Acquired Torticollis

What is the Prognosis of Acquired Torticollis? (Outcomes/Resolutions)

• Acquired Torticollis can be treated, resulting in a complete recovery in majority of the cases. The best results are when the individual is an infant or a young child. Earlier the treatment is started, better is the prognosis
• If prolonged therapy fail to achieve results, then surgical intervention may be required
• Treating the primary infection, injury, abnormality, or tumor; will in most cases automatically diminish the condition and bring about a good outcome
• Without proper treatment, the condition may worsen and become permanent. This would create lifelong discomfort and substantially affect the quality of life
• Spasmodic Torticollis, also known as Cervical Dystonia, is an abnormal neuromuscular disorder affecting neck and head muscles. It is marked by painful muscular spasms resulting in involuntary head movement to the sides, front, or back
• It is thought to occur due to an underlying neurological abnormality or disease. Majority of Spasmodic Torticollis cases occur spontaneously and there are no explanation as to why they arise

Additional and Relevant Useful Information for Acquired Torticollis:

• Spasmodic Torticollis, also known as Cervical Dystonia, is an abnormal neuromuscular disorder affecting neck and head muscles. It is marked by painful muscular spasms resulting in involuntary head movement to the sides, front, or back
• It is thought to occur due to an underlying neurological abnormality or disease. Majority of Spasmodic Torticollis cases occur spontaneously and there are no explanation as to why they arise