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The main finding is of rotational and left lateral flexion of the upper cervical spine. This postural change and the history of MVA is indicative of acute torticollis.
Torticollis essentially means twisted neck. This is a condition characterized by rotation and flexion deformity of the cervical spine, presents with acute pain and inability to move the neck, and muscular spasm. Spasmodic torticollis is a term commonly used to describe torticollis associated with a hereditary familial disorder. Acute onset or acquired torticollis is secondary to some form of traumatic, infectious, or other precipitating event. Torticollis can also be precipitated by certain medications such as ketamines, amphetamines, cocaine, and neuroleptic drugs (eg. Haldol, Thorazine, Compazine) however in this instance there may be associated ocular movement changes and protrusion of the tongue, among other signs. There may be underlying conditions such as arthritis, upper respiratory infectious disease or retropharyngeal abscess (especially in children aged 2-4), or neoplasms of the cervical spine or cervical cord which may produce a torticollis.
The characteristic clinical findings are often sufficient to diagnose torticollis, however x-rays may be performed. In cases such as the one presented here where there is a history of acute trauma producing a torticollis, the neck should be immobilized until CT or MRI is performed to further exclude the possibility of a cervical spine fracture, dislocation, or epidural hematoma. If the patient is experiencing pins and needles sensations, weakness, or numbness in the arms and/or legs, difficulty walking, difficulty with speech, or difficulty breathing then CT/MRI must be performed to exclude a potential neoplasm, infection, or other predisposing condition.
The treatment of choice for acutely acquired non traumatic torticollis includes conservative care such as chiropractic or physical therapy in the form of ice, bracing, and massage. In cases where myospasm and cervical spinal deformity persist, muscle relaxants, botox, or, in rare circumstances where torticollis may persist for months or years, surgery may be considered. In cases of acute post traumatic torticollis complicated by fracture, dislocation, and/or epidural hematoma, surgical care is warranted. Treatment options for torticollis due to familial disorders, drug complication, or other underlying disease will vary based on the specific cause.
Torticollis essentially means twisted neck. This is a condition characterized by rotation and flexion deformity of the cervical spine, presents with acute pain and inability to move the neck, and muscular spasm. Spasmodic torticollis is a term commonly used to describe torticollis associated with a hereditary familial disorder. Acute onset or acquired torticollis is secondary to some form of traumatic, infectious, or other precipitating event. Torticollis can also be precipitated by certain medications such as ketamines, amphetamines, cocaine, and neuroleptic drugs (eg. Haldol, Thorazine, Compazine) however in this instance there may be associated ocular movement changes and protrusion of the tongue, among other signs. There may be underlying conditions such as arthritis, upper respiratory infectious disease or retropharyngeal abscess (especially in children aged 2-4), or neoplasms of the cervical spine or cervical cord which may produce a torticollis.
The characteristic clinical findings are often sufficient to diagnose torticollis, however x-rays may be performed. In cases such as the one presented here where there is a history of acute trauma producing a torticollis, the neck should be immobilized until CT or MRI is performed to further exclude the possibility of a cervical spine fracture, dislocation, or epidural hematoma. If the patient is experiencing pins and needles sensations, weakness, or numbness in the arms and/or legs, difficulty walking, difficulty with speech, or difficulty breathing then CT/MRI must be performed to exclude a potential neoplasm, infection, or other predisposing condition.
The treatment of choice for acutely acquired non traumatic torticollis includes conservative care such as chiropractic or physical therapy in the form of ice, bracing, and massage. In cases where myospasm and cervical spinal deformity persist, muscle relaxants, botox, or, in rare circumstances where torticollis may persist for months or years, surgery may be considered. In cases of acute post traumatic torticollis complicated by fracture, dislocation, and/or epidural hematoma, surgical care is warranted. Treatment options for torticollis due to familial disorders, drug complication, or other underlying disease will vary based on the specific cause.