Torticollis: Difference between revisions
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Neck pain DDX}} | {{Neck pain DDX}} | ||
{{Jaw spasms DDX}} | |||
==Evaluation== | ==Evaluation== |
Revision as of 13:19, 14 November 2020
Background
- Common term for various conditions of head and neck dystonia
- Spasmodic torticollis is an abnormal contraction of the muscle in one side of the neck.
- Cause is generally idiopathic (80-90%)
Clinical Features
- Neck pain with inability to fully range laterally
Differential Diagnosis
Neck pain
- Musculoskeletal
- Torticollis
- Dystonic reaction
- Cervical spondylosis
- Cervical stenosis
- Cancer
- Epidural abscess
- Vertebral osteomyelitis
- Transverse myelitis
- Temporal arteritis
- Epidural hematoma (anticoagulation, hemophilia)
- Cervical disk herniation
- Blunt neck trauma
- Anterior horn disease
- Cervical fractures and dislocations
- Cervical radiculopathy
Jaw Spasms
- Acute tetanus
- Akathisia
- Conversion disorder
- Drug toxicity (anticholinergic, phenytoin, valproate, carbamazepine)
- Dystonic reaction
- Electrolyte abnormality
- Hypocalcemic tetany
- Magnesium
- Mandible dislocation
- Meningitis
- Peritonsillar abscess
- Rabies
- Seizure
- Strychnine poisoning
- Stroke
- Temporomandibular disorder
- Torticollis
Evaluation
- Clinical Diagnosis
- Consider cervical X-ray to rule out fracture or dislocation (unlikely to be necessary if no midline tenderness or history of trauma)
Management
Acute
- Pain control and muscle relaxation (PO benzodiazepine or opioid)
Chronic
- Benztropine
- Muscle relaxants
- Botulinum toxin
- Physical Therapy
Disposition
- Discharge