Wry neck – types and treatments

Wry neck – types and treatments

Wry neck, also known as torticollis or loxia, is a muscular condition which causes the head to tilt to one side, and is generally related to muscle spasms. There are several types of torticollis, and they affect individuals of all ages, although the most commonly discussed form of wry neck is the congenital variety. Other types include torticollis of infancy, acquired torticollis, and spasmodic torticollis. The treatment and prognosis of torticollis is as varied as the causes and ages which it affects. In this post, we will discuss each type of wry neck and the commonly recommended treatments and expected outcomes of each.

Congenital Torticollis

Thought to be the result of poor uterine positioning or trauma during birth, this form of wry neck affects 0.3-2.0% of babies. A tumor is occasionally observed in the affected muscular tissue within the first month after birth, but generally resolves on its own by 8 months of age, although the muscle may remain thickened or fibrous after the tumor goes away. The sternocleidomastoid muscle is most commonly affected, and treatment involves physical therapy or use of a TOT collar. In a small percentage of cases, surgery may be required.

Torticollis of Infancy

This form of wry neck is associated with excessive time spent on the back during early infancy, and increases a child’s likelihood of developing positional plagiocephaly (flat head syndrome). Parents are advised to change infant head position frequently in order to prevent this form of loxia, and physical therapy may also be recommended. In severe cases of torticollis of infancy, TOT collars may be prescribed. This form of torticollis is considered very preventable, if parents are educated properly as to how and when to reposition their children’s heads during early infancy. Complete recovery is expected.

For more information on torticollis in babies including treatment options, please see this article.

Acquired Torticollis

Frequently associated with an underlying condition, this type of wry neck can disappear in as little as 1 week. The causes are varied, may be benign, mild, or even life-threatening, and always warrant further investigation by a physician. Acquired torticollis may be extremely painful, although in some cases it may cause little or no physical pain. Children and adults are susceptible to acquired torticollis.  Treatment and prognoses depend on the root causes of the condition. The diagnosis embraces many underlying conditions, and is not a final diagnosis at all – it merely narrows the field of potential diagnoses that a physician considers.

Spasmodic Torticollis

Also called intermittent torticollis or cervical dystonia, this condition generally involves the sternocleidomastoid muscle. This condition is extremely painful, and involves the simultaneous involuntary contraction of multiple neck muscles. It results in rapid head jerking, and generally begins in midlife. There is some evidence to support the idea that genetics are to blame for this condition. In some cases, however, the condition results from injury, intoxication, infection, or other causes. Botulism toxin injections are the most common treatment choice for this form of wry neck, although other treatments do exist. The condition is chronic, but recent advances allow improved quality of life.

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