Torticollis: Difference between revisions
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==Background== | ==Background== | ||
[[File:Sternohyoid muscle.png|thumb|Anterior muscles of the neck.]] | |||
*Common term for various conditions of head and neck dystonia | *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== | ==Clinical Features== | ||
* | *[[Neck pain]] with inability to fully range laterally | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Neck pain DDX}} | {{Neck pain DDX}} | ||
{{Jaw spasms DDX}} | |||
{{Movement disorder DDX}} | |||
==Evaluation== | |||
== | |||
*Clinical Diagnosis | *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=== | ===Acute=== | ||
*[[analgesia|Pain control]] and muscle relaxation (PO [[benzodiazepine]] or [[opioid]]) | |||
===Chronic=== | ===Chronic=== | ||
*Benztropine | *[[Benztropine]] | ||
*Muscle relaxants | *Muscle relaxants | ||
*Botulinum toxin | *Botulinum toxin | ||
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==Disposition== | ==Disposition== | ||
* | *Discharge | ||
==See Also== | ==See Also== | ||
*[[ | *[[Neck pain]] | ||
*[[Dystonic reaction]] | |||
==References== | ==References== | ||
<references/> | |||
[[Category: | [[Category:ENT]] | ||
Latest revision as of 14:49, 11 December 2021
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
Movement Disorders and Other Abnormal Contractions
- Chorea
- Neuroleptic malignant syndrome
- Serotonin syndrome
- Hypocalcemia
- Strychnine toxicity
- Acute tetanus
- Parkinson's disease
- Mono amine oxidase inhibitor toxicity
- Phencyclidine toxicity
- Anti-NMDA receptor encephalitis
- Huntington disease
- Wilson's disease
- CVA
- Schizophrenia
- Psychotic agitation
- Dementia
- Lewy body dementia
- Vascular dementia
- Frontotemporal dementia
- Dystonic reaction
- Extrapyramidal reaction
- Torticollis
- Idiopathic movement disorder
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