An Overview of Torticollis

An Overview of Torticollis

Torticollis is a condition in which the neck is involuntarily in a turned or twisted position. It can affect children and adults. There are two main types of torticollis—congenital (present at birth) and acquired (often caused by trauma, infection, or a reaction to a medication). Congenital torticollis in infants is generally painless, while acquired torticollis often causes neck pain and restricted neck movements.
Torticollis can be, but typically is not, a medical emergency. It can usually be diagnosed with a medical history and physical examination. Sometimes, imaging of the neck is warranted. Treatment of this condition may entail physical therapy, medication, and less commonly, surgery.


Causes
The potential causes of torticollis depend on the type.

Congenital Torticollis
Congenital torticollis occurs in approximately 0.3% to 1.9% of all live births and occurs due to the shortening of one of the sternocleidomastoid muscles (SCMs).1

The SCMs are two large muscles in the neck that connect the back of your skull to your breastbone (sternum) and clavicle (on either side)

While experts are not sure exactly why some babies are born with a single shortened SCM, they suspect it may be due to one or more of the following factors:2

Crowding within the uterus during the pregnancy
Fibrosis of the muscle from bleeding and/or trauma during childbirth
Primary myopathy (muscle disease) of the SCM
Abnormal development of this muscle

Acquired Torticollis
Torticollis can develop as a consequence of a chronically strained neck position or damage to the muscles that move the neck.

Vision problems are a common cause of torticollis. This type is called ocular torticollis. And gastroesophageal reflux disease (GERD) can cause torticollis in babies.


Certain medications may also trigger torticollis. And a condition called cervical dystonia (spasmodic torticollis) causes the neck muscles to intermittently and erratically contract on their own. 3

Acquired torticollis can also occur due to scar tissue, neck arthritis, inflammation, or injury to the sternocleidomastoid or the trapezius (a muscle involved in shoulder and neck movements).4 This muscle injury or inflammation can result from trauma or from an infection of the throat or neck lymph nodes.


Rarely, there are other culprits behind torticollis, like a tumor or bleeding in the cervical spine.

Symptoms
Like the underlying causes, the symptoms of torticollis vary based on the type.


Congenital Torticollis
Congenital torticollis is a painless condition that causes babies to have their head tilted to one side and rotated to the opposite side. If the baby's left ear is closer to their left shoulder, then their face will be turned more towards the right side.2

The tilt and the rotation are not ALWAYS in opposite directions, however. Sometimes, with congenital torticollis, the baby favors rotation to the same side of the tilt.

In addition to a head and chin tilt, babies with congenital torticollis may have a lump on the side of the neck that the head is tilted toward. And babies with congenital torticollis may also have an asymmetrical appearance of the face.

Acquired Torticollis
Children and adults with acquired torticollis usually experience neck pain with certain neck movements, as well as a "locked" sensation after quickly rotating their neck. 5 Headaches, head tremors, and stiff or swollen neck muscles can accompany these symptoms. One shoulder may also appear higher than the other. 6

Other symptoms of torticollis in children and adults often correlate with the underlying cause.4

If an infection is the cause of the torticollis, a fever may be present.
With benign paroxysmal torticollis (a type of acquired torticollis in children), episodes of head tilting are associated with symptoms like vomiting, paleness, irritability, ataxia, or sleepiness.
With ocular torticollis (also a type of acquired torticollis that's more common in children), a child may tilt their head to the side to avoid a visual disturbance, like double vision.
Finally, torticollis that occurs as a reaction to a medication may be accompanied by tight jaw muscles and problems speaking.
When to See Immediate Medical Attention
It's important to note that most cases of torticollis are not life-threatening. That said, some symptoms indicate injury or irritation to the structures of the brain and/or spinal cord.

If you or your child are experiencing any of these symptoms, it's important to seek medical attention right away:

Difficulty breathing, speaking, or swallowing
Difficulty walking
Weakness, numbness, or pins and needles in your arms and legs
Incontinence (urinary or fecal)
Neck-muscle spasms and a fever
Swollen glands
Neck stiffness or swelling
Headache
Diagnosis
The diagnosis of torticollis begins with a thorough medical history.4

Your doctor may ask you questions about when your symptoms started and whether you have associated symptoms, such as pain, fever, headache, or neurological problems. and whether there was an inciting injury or trauma. They will also ask about your medication exposures.

Your doctor will then do a physical exam that is focused on your head and neck muscles and nervous system.

Sometimes imaging tests— like an X-ray, computed tomography (CT) scan, or magnetic resonance imaging (MRI)—may be warranted, especially if there is a history of trauma.

Treatment
The treatment of congenital torticollis usually involves physical therapy to help stretch and straighten out the neck. Less commonly, surgery to lengthen or release the muscle may be needed.2

The treatment of acquired torticollis is focused on treating the underlying cause (such as antibiotics for an infection) and easing symptoms.

To relieve neck pain and help relax the neck muscles, the following therapies may be recommended:7

Medications like nonsteroidal anti-inflammatories (NSAIDs) and muscle relaxants
Physical therapy and home stretching exercises
Cervical collar
Botulinum toxin (Botox) injections can also be helpful, especially for spasmodic torticollis.8

A Word From Verywell
Due to the complexity of this condition and the fact that treatment is often warranted, if you think that your child (or yourself) might have torticollis, be sure to get prompt medical attention.

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