Torticollis

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
• Anterior horn disease
• C1 and C2 fractures
• Radiculopathy

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

See Also

• Neck pain
• Dystonic reaction