Torticollis is a chronic condition in which the neck muscles contract involuntarily. This causes the head to turn and tilt to one side, and the chin to point to the opposite side. Sometimes one shoulder is lifted. The muscle contraction may be constant (fixed) or may come and go (intermittent). The abnormal posture caused by tilting the head may lead to neck pain.
Torticollis may be present at birth (congenital) or develop later in life (acquired).
The causes are not well understood. Researchers are investigating genetic, environmental, or other underlying mechanisms that may play a role.
Causes may include:
Infant's position during pregnancy or delivery
Head or neck injury
Damage or malfunction of the nervous system, specifically the basal ganglia, which is a deep brain structure
Torticollis ranges from mild to severe. It usually progresses slowly for 1-5 years, and then plateaus. However, torticollis may persist for life and can result in limited movement and deformed posture.
The doctor will ask about your symptoms and medical history, and perform a physical exam.
Tests may include:
of the neck—a test that uses radiation to take a picture of structures inside the body
of the neck—a type of x-ray that uses a computer to make pictures of structures inside the body
of the neck—a test that uses magnetic waves to make pictures of structures inside the body
The treatment for torticollis depends on whether it is congenital or acquired. Treatment generally centers on physical therapy, oral medication, botulinum toxin injections, and surgery. Possible treatments may include:
Positioning of the infant to avoid sleeping on one side
Positioning of toys to encourage turning of the head
Stretching exercises several times each day
In some situations, surgery to cut the muscle that causes torticollis
Deep brain stimulation surgery
Identifying the cause
Physical therapy to help relax the muscle and reduce pain
In some situations, surgery to cut the nerve to the muscle that is in spasm
Benzodiazepines that block Gaba-A receptors, such as diazepam
to weaken or partially paralyze the muscle—This may help improve neck posture, but only if begun soon after torticollis begins. The drug's effect wears off after several months and treatment must be repeated.
Injection of alcohol or phenol to deaden the nerve that causes the muscle contraction
Each of these options has risks and benefits. Work with your doctor to find the right treatment for you.
There are no guidelines for preventing torticollis. Early treatment may help keep the symptoms from worsening.
Preto TE, Dalvi A, Kang UJ, Penn RD. A prospective blinded evaluation of deep brain stimulation for the treatment of secondary dystonia nad primary torticollis syndromes.
Please be aware that this information is provided to supplement the care
provided by your physician. It is neither intended nor implied to be a
substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER
IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the
advice of your physician or other qualified health provider prior to
starting any new treatment or with any questions you may have regarding a