Muscular torticollis, or torticollis muscularis, is a congenital and acquired neurological disorder and is common in infants. Typically, the head is tilted to one side. The torticollis is caused by the shortening of the head nodding 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, partly congenital, partly acquired misalignment of the head. See eshaoxing for Cryptosporidiosis Definition and Meaning.
The congenital variant often occurs in infants and is characterized by the fact that the head is tilted towards the healthy side, accompanied by a shortening of the lateral head nod muscle.
The right side is affected in 75 percent of those affected with torticollis. A limited range of motion in the cervical spine makes it difficult for patients to turn their heads sideways, up and down. Other symptoms include neck pain, occasional lumps and tightness in the neck muscles, tenderness in the cervical spine, head tremors, uneven shoulder heights and a resulting lack of mobility in the shoulder and arm muscles. In extreme cases, sensory problems and motor disorders in the upper extremity can occur.
Causes
The causes of a muscular torticollis cannot be clearly clarified. A change in connective tissue within the head nod muscle seems to be responsible, but where this change comes from is not known. Whether the disease is caused by bleeding into the muscles, injuries or pressure in the muscles during childbirth still needs to be clarified medically.
An unfavorable position in the uterus can lead to torticollis. This is also known as a “head nod hematoma”. Muscular torticollis often occurs together with other malformations such as hip dysplasia or clubfeet. Inheritance has not yet been proven.
Other causes of torticollis muscularis can be hearing loss, ametropia, balance disorders, malformations of the cervical spine or a stiff neck due to drafts, which should not be confused with torticollis muscularis.
Symptoms, Ailments & Signs
In a muscular torticollis, the head is tilted to the side in conjunction with a lateral rotation to the opposite shoulder and extension or flexion of the cervical spine. The type of muscular torticollis can be described according to the positions of the head and neck: Laterocollis: the head is tilted towards the shoulder Rotational torticollis: the head rotates along the long axis Anterocollis: forward bending of the head and neck Retrocollis: hyperextension of the head and neck backwards
These incorrect postures often occur in a combined form. A torticollis can be an independent disorder or a symptom of another clinical picture. The problem may be apparent immediately after birth or may appear over the following weeks. Symptoms can vary widely, the most common being pain and immobility.
Diagnosis & History
The doctor recognizes the muscular torticollis by the typical misalignment of the head. In order to make a reliable diagnosis, he first excludes similar diseases such as e.g. B. Malformations of the cervical spine or hearing loss. X-rays of the cervical spine are also used for assessment. A hearing test is useful for infants.
If a muscular torticollis is not treated or not treated in a timely manner, it can lead to permanent damage, which results in a functional restriction of the cervical spine and promotes premature arthrosis of the cervical spine due to the load imbalance.
As a result, the bony misalignment causes a scoliosis of the cervical spine, which can cause facial asymmetries, among other things. These can no longer be completely corrected with later treatment.
If therapy starts early enough and is carried out consistently, the muscular torticollis can be corrected and possible movement restrictions can be prevented. After that, regular follow-up examinations are important. If treatment is not given in time, the muscular torticollis can no longer fully regenerate.
Complications
Due to the torticollis, those affected suffer from a severe misalignment of the head. In most cases, this is also associated with severe pain and tension. The pain often spreads to other regions of the body and can also lead to headaches or back pain.
There are also significant restrictions in movement and thus severe limitations in the patient’s everyday life, so that the quality of life is significantly reduced. The affected person’s neck is usually swollen due to the torticollis. Likewise, the symptoms of the torticollis can also have a negative effect on the hip.
This disease causes developmental disorders, especially in children, so that development is delayed. Likewise, the torticollis can have a negative effect on the patient’s hearing and also limit it. Treatment is usually carried out with the help of surgical interventions and various therapies.
In many cases, a visit to physiotherapy is also necessary. Usually there are no complications. In most cases, this also results in a positive course of the disease. The life expectancy of the patient is not affected by the torticollis.
When should you go to the doctor?
Persistent neck discomfort, headaches, or permanent tension in the shoulders and neck should be presented to a doctor. If infants and adults have a tilted head that cannot be regulated independently, the person concerned needs help. Difficulty sleeping, changes in skin complexion, and deficits in concentration and memory are considered unusual and should be evaluated by a doctor. A trembling of the head, a decrease in the usual muscle strength in the arms as well as a restricted movement are signs of an existing disorder. If lumps form, an optical defect due to unequal shoulder heights and complaints in the cervical spine, a doctor’s consultation is necessary.
Pain, problems with the shoulder joint and internal weakness should be presented to a doctor. Impaired vision, an increased risk of accidents and falls as well as reduced participation in social life is a condition that should be treated by a doctor. If everyday obligations or usual sporting activities can no longer be performed, a doctor should be consulted.
A doctor’s visit is also recommended for mood swings, general behavioral abnormalities, or personality changes. If there is a persistent depressive or aggressive appearance, a permanent loss of well-being or feelings such as shame, secondary diseases can develop if left untreated.
Treatment & Therapy
Timely treatment of the muscular torticollis is of decisive importance for the course. There are two different options:
- conservative treatment
- surgical treatment
Conservative treatment:
Conservative treatment can be carried out without hospitalization. Correction of the misalignment is attempted with various measures:
- opposite positioning of the head
To correct the misalignment, the baby is gently offered attention stimuli in the opposite direction, so that he has to turn his head to perceive them.
- Avoid prone position
It is very important to position the infants on their backs or sides. Lying on your stomach could increase the problem.
- physiotherapy
Through careful stretching exercises, the head is moved in the opposite direction to achieve a healthy position. It is essential that parents regularly carry out the exercises they have learned at home. In most cases, surgical correction is not necessary if treatment is given early.
Surgical treatment:
If conservative treatment does not bring sufficiently positive results or has started too late, surgical correction of the head nod muscle is sometimes unavoidable. The neck muscle is severed at the base of the breastbone to correct the misalignment. The head must then be fixed with a neck tie or a plaster cast in order to immobilize it for three to four weeks.
Outlook & Forecast
Muscular torticollis generally has a good prognosis if conservative therapy is started early enough and carried out consistently. In about 90 percent of the children affected, the torticollis can be corrected with professional physiotherapy and even without an operation. Even in the case of an early operation, the prognosis for those affected is very good. In most cases, the misalignment can be corrected without restricting movement. However, regular follow-up examinations are important in order to detect a possible recurrence in good time.
Without treatment, however, the malformation can no longer be completely compensated for. If the muscular torticollis remains untreated or is treated too late, complications can also occur. Under certain circumstances, a functional limitation of the cervical spine can occur. An uneven load on the neck can also lead to arthrosis of the loaded cervical vertebrae. In addition, a bony misalignment of the cervical and thoracic spine can develop over time.
If left untreated, the facial skull on the affected side and the back of the head on the opposite side can visibly flatten due to shifted pressure bearing surfaces. Facial asymmetry becomes more apparent as we grow. On the affected side, the face is relatively short, the ears and eyes are at different levels. These facial asymmetries are not always fully correctable in the late stages.
Prevention
There is no active way to prevent muscular torticollis. The problem can be caused by an unfavorable position in the uterus over which one has no influence. Injuries caused during childbirth can also be triggers. You can only improve or completely correct the misalignment by taking the measures listed above.
Aftercare
Follow-up care depends on the severity of the muscular torticollis. Follow-up care should begin at an early stage so that a malposition can be counteracted. As part of aftercare, exercise and sport relieve and also have a preventive effect. Sports exercises with targeted stretching of the relevant 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 through aftercare treatments as part of manual therapy or through therapeutic treatments by a physiotherapist or doctors specializing in chirotherapy. If parts of the muscles are particularly painful and impaired due to the muscular torticollis, local pain treatments can be helpful.
During follow-up, regular meetings are held with the attending physician to determine the progress of the recovery process. In this way, deterioration can be recognized 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 when lying down at rest and sleeping times.
Special health pillows can be helpful here. They support the neck optimally, both in the side position and in the back position. The head is straight. As a result, better relaxation of the muscles in the neck area can be achieved. Tensions can be released.
You can do that yourself
A muscular torticollis (torticollis muscularis) can have various causes, which is why it is very important to see a doctor in good time. Only a thorough examination can determine whether it is actually a question of muscular torticollis or another disease.
Following the diagnosis, patients must follow the therapy exactly. Otherwise there is a risk that the misalignment will remain. The recommendations include targeted physiotherapy, which is carried out regularly. There are also special positioning techniques that counteract torticollis. Aside from surgery, stretching exercises also help. Patients should be careful to avoid pain. Early treatment counteracts the malposition of the head and also prevents consequential damage. This is very important in both children and adult patients.
With timely action and intensive physiotherapy, the malposition can be corrected so that the spine and skull are not put under too much strain. Postural errors should also be avoided, as they could lead to an aggravation of the torticollis. Ergonomic equipment counteracts the unfavorable consequences of muscular or acute torticollis.
