TORTICOLLIS: PHYSIOTHERAPY MANAGEMENT

TORTICOLLIS

INTRODUCTION:

Left side torticollis

  • Torticolis is a condition (also known as ‘wryneck’) in which the baby’s head is tilted. The head often rotates towards one shoulder and tilts away to the opposite side. The term ‘congenital’ is also sometime used when describing torticollis. This means that it is present at or shortly after birth. Babies treated early with physiotherapy programmes usually respond well to treatment.
  • Torticollis is a symptom related to turning or bending of the neck. Many different causes are possible. In newborns, torticollis usually results from injury during labor and delivery or the infant’s position in the womb. Less often, it is caused by birth defects. In older children, torticollis may result from injuries to the neck muscles, common infections, or other causes.
  • Painful spasms of the neck muscles may occur.
  • Other symptoms may be present, depending on the cause. For example, there may be a tender lymph node (gland) if the cause is infection.

TYPES:

Different types of torticollis

  • Congenital torticolis.
  • Acquired torticolis.

ANATOMY:

Anatomy of torticollis

  • The normal physiologic range of rotation of the atlas on the axis is 25-53 degrees to either side. The transverse ligament is the primary stabilizer of the atlanto-axial joint and prevents excessive anterior motion of the atlas on the axis. It extends behind the dens, between the medial portions of the lateral masses of C1.
  • The paired alar ligaments act as secondary stabilizers to prevent anterior shift. The alar ligaments extend from the lateral aspect of the dens tip to the medial aspect of the occipital condyles, with a lower portion attaching to the medial aspect of the lateral masses of C1.
  • The sternocleidomastoid muscle has a sternal and clavicular head. The sternal head is directed from the manubrium sterni superiorly, laterally and posteriorly and the clavicular from the medial third of the clavicle vertically upward. It runs to the mastoid process.
  • It enables an ipsilateral lateral flexion and a contralateral rotation. The muscle extends the upper part of the cervical spine and flexes the lower part.

ETIOLOGY:

  • Muscular in more than 80% of the cases. Types muscular torticollis:
  • – Fibromatosis colli: torticollis with palpable mass in the SCM;
  • – Tightness of the SCM without an apparent mass;
  • Postural torticollis with neither mass or tightness.
  • Birth trauma: facet dislocation, tears in the sternocleidomastoid muscle
  • Congenital anomalies of the craniovertebral junction: occipitoatlantal fusion or Klippel-Feil syndrome.
  • Sternocleidomastoid tumour.
  • Ocular abnormalities.
  • Intrauterine mechanical factors

Characteristic features of torticollis

CAUSES:

  • Sitting or sleeping in an unusual position without adequate neck support.
  • Poor posture when looking at a computer screen.
  • Carrying heavy unbalanced loads (for example, a briefcase or shopping bag).
  • Allowing certain muscles of the neck to be exposed to cold (sleeping in a draught).

SYMPTOMS:

  • The twisting of your neck (torticollis) occurs when your muscles supporting the neck on one side are painful.
  • The pain is usually on one side of your neck and stiffness of the muscles in that area twists the neck to one side.
  • You may find it very difficult when you try to straighten your neck, due to pain. Occasionally, the pain is in the middle of your neck.
  • The pain may spread to the back of your head or to your shoulder. The muscles of your affected side may be tender. Pressure on certain areas may trigger a ‘spasm’ of these muscles. Movement of your neck is restricted, particularly on one side.

DIAGNOSIS:

  • A thorough neurologic examination should be performed, and anteroposterior and lateral radiographs of the cervical spine should be obtained.
  • A CT scan or MRI of the head and neck is necessary for any patient with persistent neck pain or with neurologic signs and symptoms.

TREATMENTS:

  • Medicines:
  • Pain killer are often helpful. such as,
  • Paracetamol at strength is often sufficient.
  • Anti inflammatory painkillers.
  • A stronger pain killer such codeine.
  • A muscle relaxant such as diazepam.
  • Other treatments such as:
  • Rest.
  • A good posture.
  • A firm supporting pillow.
  • Heat pack.

PHYSIOTHERAPY TREATMENTS AND EXERCISES:

Stretching exercise

Torticollis exercises

  • Positioning.
  • Gentle range of motion exercises for neck.
  • Stretching of sternocleido mastoid muscle.
  • Stretching the muscle in a prone position both actively and passively.
  • Stretching the muscle in a lateral position supported by a pillow (have infant lie on the side with the neck supported by pillow). Affected side should be against the pillow to deviate the neck towards the non-affected side.
  • Active rotation exercises in supine, sitting or prone position (use toys, lights and sounds to attract infant’s attention to turn neck and look toward the non-affected side).
  • Passive cervical rotation.
  • Strnengthening exercises.
  • Activities to encourage active head movement.
  • Visual tracking.
  • Lateral head tilt.
  • Therapy ball exercises.
  • Side sitting exercises.
  • Hands and knees.
  • Kneeling to standing.
  • Assisted rolling.
  • Proped sidelying.
  • Torticollis treatment at home for babies:
  • The best method of torticollis treatment is to encourage your baby to turn his or her head in both directions. This will help to loosen tense neck muscles and tighten the loose ones. Here are some exercises to try:
  • When your baby wants to eat, offer the bottle or your breast in a way that encourages your baby to turn away from the favored side. (Use your child’s desire to eat to encourage him or her along!)
  • When putting your baby down to sleep, position him or her to face the wall. Since babies prefer to look out onto the room, your baby will actively turn away from the wall and this will stretch the tightened muscles of the neck.
  • During play, draw your baby’s attention with toys and sounds to make him or her turn in both directions.

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