Muscular torticollis, or torticollis muscularis, is a congenital and acquired neurological condition and is common in infants. Typically, the head is tilted to one side. Torticollis is caused by the shortening of the head-nicker muscles. If not treated in time, there is a risk of aggravation and neurological problems.
What is muscular torticollis?
In medicine, the term muscular torticollis denotes a rare deformity of the head, some of which is congenital and some acquired. The congenital variant often occurs in infants and is noticeable because the head is tilted toward the healthy side, accompanied by a shortening of the lateral head-nicker muscle. The right side is affected in 75 percent of those with torticollis. A limited range of motion of the cervical spine makes it difficult for patients to turn their head to the side and up and down. Other symptoms include neck pain, occasional knotting and tension of the neck muscles, tenderness of the cervical spine, head tremors, uneven shoulder heights, and a resulting lack of mobility of the shoulder and arm muscles. In extreme cases, sensitivity problems and motor dysfunction in the upper extremity may occur.
Causes
The causes of muscular torticollis cannot be clearly determined. A connective tissue change within the head nodule muscle appears to be responsible, but where this change comes from is not known. Whether the condition results from muscle hemorrhage, injury, or pressure in the muscles during birth remains to be medically determined. An unfavorable position in the uterus can lead to torticollis. This is also called “head nodding hematoma.” Muscular torticollis occurs frequently together with other malformations such as hip dysplasia or clubfeet. Heredity has not yet been proven. Other causes of torticollis muscularis may include hearing loss, defective vision, balance disorders, malformations of the cervical spine, or stiff neck due to drafts, but these should not be confused with torticollis muscularis.
Symptoms, complaints, and signs
In muscular torticollis, the head is tilted to one side, in association with lateral rotation to the opposite shoulder and extension or flexion of the cervical spine. The type of muscular torticollis can be described depending on the positions of the head and neck:
Laterocollis: The head is tilted toward the shoulder.
Rotational torticollis: The head rotates along the longitudinal axis
Anterocollis: forward flexion of the head and neck
Retrocollis: backward overextension of the head and neck
Often these malpositions occur in combined form. Torticollis can be a disorder in its own right or a symptom of another medical condition. The problem may be apparent immediately after birth or may appear over the course of the following weeks. Symptoms can vary widely, of which the most common are pain and immobility.
Diagnosis and course
The physician recognizes muscular torticollis by the typical misalignment of the head. To make a reliable diagnosis, he or she first rules out similar conditions, such as malformations of the cervical spine or hearing loss. In addition, X-rays of the cervical spine are used for assessment. In infants, a hearing test is useful. If muscular torticollis is not treated or is not treated in time, permanent damage can occur, resulting in functional impairment of the cervical spine and, due to the load imbalance, premature joint arthrosis of the cervical spine. As a result, a scoliosis of the cervical spine is formed due to the bony malposition, which can cause facial asymmetries, among other things. These can no longer be completely corrected if treatment is delayed too long. If therapy begins early enough and is carried out consistently, muscular torticollis can be corrected well and possible movement restrictions can be prevented. After that, regular follow-up examinations are important. If not treated in time, muscular torticollis cannot be fully regenerated.
Complications
As a result of torticollis, affected individuals suffer from severe head malposition.In most cases, this is also associated with severe pain and tension. It is not uncommon for the pain to spread to other regions of the body and can also lead to headaches or back pain. It also leads to significant restrictions in movement and thus to severe limitations in the patient’s everyday life, so that the quality of life is considerably reduced. The neck of the affected person is usually swollen due to torticollis. Similarly, the symptoms of torticollis can also have a negative effect on the hip. Especially in children, this condition causes developmental disorders, so that it is delayed. Similarly, torticollis can have a negative effect on the patient’s hearing and limit it as well. Treatment is usually carried out with the help of surgical interventions and various therapies. In many cases it is also necessary to attend physiotherapy. As a rule, there are no complications. In most cases, the course of the disease is also positive. The patient’s life expectancy is not affected by torticollis.
When should you go to the doctor?
Persistent discomfort of the neck, headaches or permanent tension of the shoulders and neck should be presented to a doctor. If there is a misalignment of the head in both infants and adults that cannot be regulated independently, the affected person needs help. Sleep disturbances, changes in skin appearance, and concentration and memory deficits are considered unusual and should be evaluated by a physician. A trembling of the head, a decrease in the usual muscle strength in the arms as well as a restriction of movement are signs of a present disorder. If there is a formation of lumps, a visual blemish due to unequal shoulder heights and discomfort of the cervical spine, it is necessary to consult a doctor. Pain, problems of the shoulder joint as well as internal weakness should be presented to a doctor. Impaired vision, increased risk of accidents and falls, and reduced participation in social life are conditions that should be treated by a physician. If daily obligations or usual sporting activities can no longer be performed, a doctor should be consulted. If there are fluctuations in mood, general abnormalities in behavior or changes in personality, a visit to the doctor is also recommended. If there is a persistent depressive or aggressive demeanor, a permanent loss of well-being, or feelings such as shame, secondary illnesses may develop if left untreated.
Treatment and therapy
Timely treatment of muscular torticollis is of crucial importance for its course. There are two different options:
1. conservative treatment
2. surgical treatment
Conservative treatment:
Conservative treatment can be performed without hospitalization. Various measures are used to try to correct the deformity:
- Opposite positioning of the head
To correct the misalignment, the infant is gently offered attention stimuli in the opposite direction, so that he must turn his head to perceive them.
- Avoidance of the prone position
It is very important to place the infants on their back or side. The prone position could increase the problem.
- Physiotherapy
Through careful stretching exercises, the head is moved in the opposite direction to achieve a healthy position. Indispensable here is that parents regularly perform the learned exercises at home. In most cases, this eliminates the need for surgical correction if treated early. Surgical treatment:
If conservative treatment does not produce sufficiently positive results or has started too late, surgical correction of the head nodule muscle is sometimes unavoidable. In this procedure, neck muscle is cut at the base of the sternum to correct the malposition. The head must then be immobilized with a neck tie or cast to keep it immobilized for three to four weeks.
Outlook and prognosis
Muscular torticollis generally has a good prognosis if conservative therapy is started early enough and is also performed consistently. In about 90 percent of affected children, the torticollis can be corrected with professional physiotherapy and even without surgery.Even in the case of early surgery, the prognosis for affected individuals is very good. In most cases, the crooked position can be corrected without restricting movement. However, regular follow-up examinations are important to detect any recurrence in good time. Without treatment, however, the deformity can no longer be completely corrected. If muscular torticollis remains untreated or is treated too late, complications can also arise. Under certain circumstances, a functional restriction of the cervical spine can occur. Uneven loading of the neck can also lead to joint arthrosis of the loaded cervical vertebrae. In addition, a bony deformity of the cervical and thoracic spine may develop in the course. If left untreated, the facial skull of the affected side and the back of the head of the opposite side may also flatten visibly, due to displaced pressure bearing surfaces. The facial asymmetry becomes more pronounced as the child grows. On the affected side, the face is relatively shortened, and the ears and eyes are at different levels. These facial asymmetries are not always fully correctable in the late stage.
Prevention
There is no active way to prevent muscular torticollis. The problem may be caused by an awkward position in utero over which one has no control. Injuries caused by childbirth can also be triggers. One can only improve or completely correct the malposition by the measures listed above.
Aftercare
Follow-up care is based on how severe the muscular torticollis is. Follow-up care should begin early so that malposition can be counteracted. As part of aftercare, exercise and sport alleviate the problem and also have a preventive effect. Sports exercises with targeted stretches of the corresponding neck muscles can help. After the pain symptoms have subsided, it is necessary to release the blockages in the cervical spine and establish complete, pain-free mobility. This should be done by follow-up treatments in manual therapy or therapeutic treatments by a physiotherapist or doctors of chiropractic. If parts of the musculature are particularly painful and impaired due to muscular torticollis, local pain treatments may be helpful. During follow-up care, regular discussions are held with the treating physician to determine the progress of the recovery process. In this way, deteriorations can be detected and treated at an early stage. Lifestyle habits are also discussed. It should also be questioned whether the head and neck area is well supported while lying down at rest and at bedtime. Special health pillows can be helpful here. They support the neck optimally, both in the side position and in the back position. The head lies straight. This can lead to better relaxation of the muscles in the neck area. Tensions can be released.
This is what you can do yourself
Muscular torticollis muscularis can have various causes, so it is very important to see a doctor in time. Only a thorough examination can determine whether it is actually muscular torticollis or some other condition. Following the diagnosis, patients must adhere strictly to the therapy. Otherwise, there is a risk that the malposition will remain. Recommendations include targeted physiotherapy, which is performed regularly. There are also special positioning techniques that counteract torticollis. Apart from surgery, stretching exercises also help. Those affected should proceed carefully to avoid pain. Early treatment counteracts the misalignment of the head and also prevents secondary damage. This is very important for both children and adult patients. Timely action and intensive physiotherapy can correct the malposition so that the spine and skull are not subjected to too much stress. Postural errors should also be avoided, as they could lead to an aggravation of torticollis. Ergonomic furniture counteracts the unfavorable consequences of muscular or acute torticollis.
