Key points
The term stiff neck it refers to a vicious tilt of the head on the neck, always involuntary and with a sudden and painful onset. In other words, torticollis is a transient "deformity" of the cervical tract which is characterized by the abnormal position assumed by the head after an imperfect or abrupt rotation of the neck.
Variants
- Muscular / osteoarticular torticollis can be a consequence of colds, viral infections, tuberculosis, arthritis, arthrosis and rheumatism;
- Symptomatic torticollis may depend on neuralgia, paralysis, otitis, thyroid affections, strabismus, migraine, convulsive fever;
- Congenital torticollis is a pathology due to malformative diseases originating during intrauterine life.
Diagnosis
In case of torticollis, it is necessary to undergo diagnostic tests (usually radiographic) to rule out any serious traumatic injuries.
Therapy
The therapy for torticollis depends on the cause that originated it. The oral administration of NSAIDs or muscle relaxants, possibly accompanied by the infiltration of analgesics in the myalgic points, can bring relief. Sometimes, the use of the orthopedic collar is recommended.
Definition of torticollis
In medicine, the term "torticollis" defines an "imperfect tilt of the head on the neck, always involuntary and permanent, with a sudden and painful onset. In common parlance, torticollis is considered an acute and painful blockage of the neck that typically arises during an abrupt rotation or sudden bending of the cervical spine. Neck pain generally lasts for a period ranging from a few days to a couple of weeks. The torticollis is therefore a deformity of the cervical tract which is characterized by the anomalous position assumed by the head after a rotation of the neck.
The most common variant of all is a stiff neck muscular, a spastic and extremely painful contraction of the neck muscles, typical of the young age. There is also the form traumatic stiff neck, which occurs after an accident or a fall. The stiff neck symptomatic on the other hand, it recognizes various causes of origin (eg altered vision, neurological pathologies, etc.). Last - but not least - we remember the torticollis congenital, caused by a retraction of the sternocleidomastoid muscle or by bony malformations of the cervical vertebrae.
Muscular / osteoarticular torticollis
Muscular / osteoarticular torticollis is often caused by severe contracture of the sternocleidomastoid, splenium and levator scapulae (levator scapula muscle).
In addition to these factors, further and possible defendants of muscle torticollis are:
- Cold blows and drafts
- Viral infections (e.g. caused by West Nile virus)
- Tuberculosis
- Arthritis and arthrosis
- Rheumatism
On the occasion of muscular torticollis, palpation of the neck is very painful. The standard treatment for the muscular variant involves the use of an orthopedic collar, possibly associated with drug therapy with NSAIDs (non-steroidal anti-inflammatory drugs), muscle relaxants or corticosteroids. Sometimes, also the infiltration of analgesics in the painful muscle points (myalgic). it can provide quick, albeit temporary, relief. Some patients with torticollis benefit from acupuncture or targeted physiotherapy massages (performed by experienced and qualified personnel).
"DDIM" torticollis
The abbreviation "DDIM" stands for "minor intervertebral pain disorder". Similarly to the muscular variant, DDIM torticollis is quite common and causes a myalgic reaction with possible points of extreme sharpening (points trigger).
More often than not, DDIM torticollis is caused by a rapid twisting movement of the neck, sometimes barely hinted at. This form of torticollis often involves the cervical area between the C2 and C3 vertebrae.
DDIM torticollis must be differentiated from a severe traumatic cervical injury. To do this, the patient must undergo radiographic tests to ascertain the origin of the pain.
The ideal treatment to relieve DDIM stiff neck pain is the use of an orthopedic collar, accompanied by specific relaxation maneuvers operated by a competent healthcare professional.
In acute torticollis - whether of muscular origin or DDIM - the neck is locked in lateral inclination, and every slightest movement generates a sharp, penetrating and unbearable pain. Neck "lock" normally affects only one side, ie rotation is allowed on one side but denied on the other. However, in some patients, neck movement is prevented on both sides.
The differential diagnosis between muscular torticollis and DDIM torticollis is important, but not always so immediate. Generally, when manipulation is possible (however always extremely painful), and subsequently causes immediate relief, it is more likely that you are faced with a DDIM stiff neck.
Symptomatic torticollis
Symptomatic torticollis is an acquired torticollis of various origins, therefore dependent on several different causes:
- Neuralgia: radiculitis, neuritis
- Lesions of the extrapyramidal system (group of pathways and nerve centers that act at the level of the motor sphere)
- Psychotic or epileptic spasms
- Central or peripheral paralysis
- Otitis media, possibly associated with mastoiditis or labyrinthitis (internal otitis), responsible for stiff neck otogen
- Thyroid diseases (e.g. voluminous goiter)
- Rhino-pharyngeal affections
- Strabismus or astigmatism, responsible for ocular torticollis. In this case, the torticollis is due to an imperfect attitude taken by the head of the patient suffering from vision pathologies, in an attempt to "correct" the visual defect
- Severe migraine
- Convulsive fever
Therapy is symptomatic, therefore it must be established according to the triggering cause. If the pharmacological treatments are unsuccessful, we proceed with a surgical intervention.
Congenital torticollis
This variant of torticollis is a pathology due to malformative diseases, originating during intrauterine life. In turn, congenital torticollis is distinguished in:
- CONGENITAL TORCICOLLO MYOGEN: this is the most frequent variant of congenital torticollis, essentially due to the retraction of the sternocleidomastoid muscle. Patients affected by myogenic torticollis present a "clear lateral tilt of the head, associated with rotation of the face to the opposite side and craniofacial asymmetry. During the diagnostic examination, during the initial stage it is possible to detect a hematoma along the involved muscle." In a second moment, the hemorrhagic infarction undergoes a fibrous-scarring transformation (with retraction of the muscle fibers).
Although the affected patient is able to flex and extend the neck, correction of the deformity is nearly impossible. The treatment is carried out in stages. Within the first year of life, the patient is treated simply with anesthetic ointments and corrective plaster showers. Subsequently, surgery is carried out to correct the physical damage as much as possible. The patient will be able to wear the orthopedic collar during the postoperative period.
- CONGENITAL TORCICOLLO OSTEOGEN (bone): the causes are to be found in morphological abnormalities of the spine, such as:
- atlanto-occipital fusion also called ocipitalization of the atlas
- Klipper-Feil syndrome: narrowing of two or more cervical vertebrae
- hemisponilia: failure to develop one half of the spinal column
- Sprengel's deformity or congenital high scapula: failure of the scapula to descend into its natural position
- cervical spina bifida
Congenital torticollis is rather difficult to diagnose at birth, since the disorder presents an extremely slow but progressive evolution. The clinical picture is evident in the age between 10 and 20 years. Bone congenital torticollis is responsible for lateral head deviation, neck shortness, cervical scoliosis, brachialgia, and limitation of movement.
The most appropriate treatment for the treatment of congenital bone torticollis consists in the application of specific corrective devices.
Spastic torticollis (or cervical dystonia) is a disorder due to the contraction of the neck muscles, responsible for abnormal movements, torsion of the neck and the assumption of an "unusual position of the head. This form of torticollis is treated with injections of botulinum toxin (eg . NeuroBloc).
