Torticollis

Torticollis, also known as wry neck, is a neurological movement disorder syndrome in which sustained or repetitive muscle contractions result in twisting and repetitive movements or abnormal fixed postures defined by an abnormal, asymmetrical head or neck position, which may be due to a variety of causes. 

The most common case has no obvious cause, and the pain and difficulty with turning the head usually goes away after a few days, even without treatment

Signs and symptoms

Torticollis is a fixed or dynamic tilt, rotation, with flexion or extension of the head and/or neck. The type of torticollis can be described depending on the positions of the head and neck

• Neck pain
• Occasional formation of a mass
• Thickened or tight sternocleidomastoid muscle
• Tenderness on the cervical spine
• Tremor in head
• Unequal shoulder heights
• Decreased neck movement

Types 

• laterocollis : the head is tipped toward the shoulder
• rotational torticollis : the head rotates along the longitudal axis
• anterocollis : forward flexion of the head and neck
• retrocollis : hyperextension of head and neck backward

Anatomy
The underlying anatomical distortion causing torticollis is a shortened sternocleidomastoid muscle. This is the muscle of the neck that originates at the sternum and clavicle and inserts on the mastoid process of the temporal bone on the same side. There are two sternocleidomastoid muscles in the human body and when they both contract, the neck is flexed. The main blood supply for these muscles come from the occipital artery, superior thyroid artery, transverse scapular artery and transverse cervical artery. The main innervation to these muscles is from cranial nerve XI (the accessory nerve) but the second, third and fourth cervical nerves are also involved. Pathologies in these blood and nerve supplies can lead to torticollis.

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