Orthopedics-Online

Torticollis

Synonyms: Torticollis, Torticollis spasmodicus

English: wry neck, loxia

Torticollis - What is it?

Torticollis (Torticollis) is a Collective term for many different innate or acquired deformities of Neckwho are in an asymmetrical posture of the Neck or des Head result. The term torticollis used in medical terminology is derived from the Latin words tortus for twisted and collis for neck.

Appointment with a back specialist?

I would be happy to advise you!

Who am I?
My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
Various television programs and print media report regularly about my work. On HR television you can see me every 6 weeks live on "Hallo Hessen".
But now enough is indicated ;-)

The spine is difficult to treat. On the one hand it is exposed to high mechanical loads, on the other hand it has great mobility.

The treatment of the spine (e.g. herniated disc, facet syndrome, foramen stenosis, etc.) therefore requires a lot of experience.
I focus on a wide variety of diseases of the spine.
The aim of any treatment is treatment without surgery.

Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

You can find me in:

Lumedis - your orthopedic surgeon
Kaiserstrasse 14
60311 Frankfurt am Main

Directly to the online appointment arrangement
Unfortunately, it is currently only possible to make an appointment with private health insurers. I hope for your understanding!
Further information about myself can be found at Dr. Nicolas Gumpert

What is the best way to treat the torticollis?

Treatment of torticollis depends on the cause and the exact severity.

Most often the so-called acute torticollis (stiff neck) occurs, which is caused by muscle tension or too strong a draft. It usually disappears within a few hours or a few days.

If the symptoms are a little worse, the treatment of the acute torticollis is best done by a trained doctor or physiotherapist, who can compensate for the misalignment with certain pulling and movement techniques. As this can be very painful, it is recommended that you take a sufficient amount of pain reliever, such as paracetamol or aspirin, at the same time.

The therapy of a rheumatic torticollis can consist on the one hand of eliminating the inflammation with appropriate medication, but on the other hand also in manual therapy or physiotherapeutic measures.

A torticollis resulting from large scars on the neck is called a torticollis. In addition to extensive physiotherapy for loosening the tissue, renewed surgical intervention by a plastic surgeon is a possible therapy.

If the torticollis is congenital, it is first treated with physiotherapy. Particularly in the simpler stages of the disease, it can be sufficient to lay the newborn on the stomach frequently, as this tends to stress the neck muscles and thus develop more evenly and any deformities that may be present disappear on their own.

In addition, a kind of ruff can be worn for support, which is specially adapted to fix the problem precisely. About 10% of congenital crooked necks cannot be treated with conservative measures, or only unsatisfactorily, so that the operation is the method of choice here.

If a congenital torticollis is not treated, the constant incorrect posture of the head can lead to a crooked spine over time (scoliosis). At the same time, the inclined side of the face can lag behind in growth. Therefore, therapy as early as possible is always advisable.

In the case of an osseous torticollis caused by bone malformations in the neck area, surgery to correct the bone deformity is usually the first choice. The definitive therapy must, however, be assessed on a case-by-case basis, depending on how strong the deviation from the normal picture is.

If a bacterial infection is the cause of the torticollis (infectious torticollis), treatment consists of antibiotic therapy.

A spastic torticollis is caused by damage to the brain that causes spastic movements in the neck. The therapy of the spastic torticollis is difficult, as often only the symptoms, i.e. the torticollis itself, but not the damage to the brain, can be treated.

How long will the treatment take?

The duration of the complaints and the chances of a complete cure depend heavily on the cause of the torticollis.

An acute torticollis as well as the bacterially caused infectious torticollis can be completely eliminated within a short time. The acute torticollis usually disappears after a few days. In the case of an infectious torticollis, the time until recovery depends on the prescribed antibiotic therapy. This usually takes about 2 weeks.

Unfortunately, many forms of torticollis cannot be completely cured because the underlying cause cannot be fixed. This includes, for example, the spastic torticollis. Treatment can, however, contain the symptoms in order to reduce the patient's quality of life as little as possible.

Symptoms of a torticollis

In general, patients often complain of a misalignment of the head to the neck. This misalignment is either organically caused, for example by a muscle that is too short, or is actively taken in order, for example, to spare an irritated nerve. This is why a torticollis can occur with or without pain, but in all cases it is an uncomfortable situation that makes seeing and communicating with other people much more difficult.

There are many different external forms of torticollis, each with their own name depending on how the neck and head relate to one another. These include:

the laterocollis, in which the head is tilted either to the right or to the left towards the shoulder
the rotatory torticollis, in which the head is constantly moving as if it were being shaken
the anterocollis, with the head and neck tilted forward
the retro collis, in which the head and neck are tilted backwards

Classically, however, one does not observe an isolated form, but a combination of several of these movements.

Causes of a torticollis

A torticollis can have many different causes, some of which can already be congenital, others are only acquired in the course of life. That is why there is a general distinction between congenital and acquired forms of torticollis.

Congenital muscular torticollis (torticollis muscularis congenitus)

The causes of a congenital torticollis are not yet fully understood, but it is believed that the congenital torticollis is caused either by an incorrect position of the embryo in the mother's womb or various traumas during childbirth. This almost always affects one of the two large lateral neck muscles (Sternocleid mastoid muscle). The muscle can be damaged by various mechanisms, whereupon it is often shortened and rebuilt by connective tissue, i.e. its function declines.

Normally, both muscles pull the head with the same force and thereby fix it to the neck. However, if one of the muscles is weakened or shortened as a result of the injury, an imbalance arises between the two muscles; a torticollis arises. Shortening a muscle causes the head to tilt in that direction. At the same time, the head turns in the other, the healthy direction.

Even simple damage to this neck muscle, for example due to trauma during childbirth, can be the cause of a torticollis. The torticollis usually disappears on its own when the bruise in the muscle disappears after a few weeks and both muscles have the same strength again. In most cases, the torticollis is not noticed in newborns immediately after birth, but only after 7-10 days. It is particularly easy to see while sleeping, as torticollean newborns always keep their heads in the same position while sleeping.

Acquired torticollis

The acquired torticollis develops in the course of life and can have many different causes. The most common causes of an acquired torticollis include:

bony disorders
Inflammation of the salivary glands and tonsils
different forms of rheumatism
Abscesses or
Brain tumors

Osseous torticollis

In the bony torticollis, a malformation or misalignment of the bones in the neck area is the decisive cause of the torticollis. There are many different causes for the osseous torticollis, the most common of which are vertebral injuries and vertebral fractures, which are then not healed straight but in a misalignment.

Since the bony structure takes over most of the fixation of the head to the trunk, even small deviations in healing from the normal axis can lead to an osseous torticollis.

Inflammatory torticollis

If the torticollis is due to an inflammation of the soft tissues of the neck (larynx, tonsils or salivary glands), it is called an infectious torticollis.

The cause of this is usually a bacterial infection. The infection causes swelling and pain, which often leads to the head being brought into a relieving position that is equivalent to a tilted position.

Spastic torticollis (Torticollis spasticus)

With spastic torticollis, the head is not permanently tilted to one side, but recurring movements of the head to one side, i.e. spasticity. A spastic torticollis is more common in children than adults.

The most common causes of a spastic torticollis are damage to the brain as a result of an accident or an inflammation of the brain (encephalitis). This then leads to cramps in the neck muscles (tonic-clonic cramps).

Acute torticollis (torticollis acutus)

Acute torticollis, also popularly referred to as stiff neck, can have various causes. The acute torticollis often arises from strong muscle tension as a result of poor posture or strong drafts, and the resulting torticollis is more of a relieving posture in order not to further strain the muscle.

This usually disappears on its own within a few hours or days. However, an acute torticollis can also develop in connection with a cervical spine syndrome (cervical spine syndrome). Here, certain nerves (meningeal nerves) are irritated by signs of wear (degenerative changes) in the cervical vertebra area, which means that the affected patient automatically tilts his neck to one side. If this gentle posture is taken over a period of time, there is also extensive tension in the muscles in the shoulder and neck area.

Rheumatic torticollis (Torticollis rheumaticus)

The rheumatic torticollis, like the acute torticollis, usually occurs suddenly. The cause of the rheumatic torticollis is severe pain in the vertebral joints due to rheumatic inflammation. In order to avoid further pain, the patients take a relieving posture here too.

Torticollis (torticollis cutaneus)

As the name suggests, the causes of the torticollis are scars in the neck area. However, a torticollis only occurs when the scar tissue makes up a large part of the neck.

Causes of a torticollis can be injuries, burns or accidents of all kinds with scarring as a result, but also major surgical interventions in the neck area.

Other forms

A torticollis can often also be caused by the fact that a patient often takes the same posture, for example with salespeople at the checkout who are always looking in the same direction. After a while, this temporary posture at work can turn into a fixed malposition, which can cause neck and back pain.

If a patient complains of a one-sided hearing loss, a torticollis often arises to compensate for the hearing ability. (Torticollis acousticus)

Visual disturbances can also be the cause of a torticollis (torticollis opticus). If, for example, an eye muscle is paralyzed and the eye movements are disturbed, the person affected can try to straighten the field of vision by means of a crooked neck.