Wryneck
Definition
Wryneck is a medical condition in which head is tilted at one side and chin is turned to the other side.
There are two types of wryneck congenital muscular torticollis and acquired muscular torticollis.
Alternative names
Torticollis, Cervical dystonia, Stiff neck, Spasmodic torticollis
Causes, incidence and risk factors
It may be due to defects in ability of brain to process chemical messages which help in the brain cells to correspond to each other.
Congenital muscular torticollis
It is due to inherited genes. It is believed that it is due to intrauterine malposition or trauma at birth. In this there is an injury to sternocleidomastoid muscle. Due to this there is a restricted range of motion in rotation as well as lateral bending due to shortened or excessively contracted sternocleidomastoid muscle. The head is tilted at an angle and the chin turns to the opposite side.
There may be tumor in the affected muscle. This may happen at the age of two to four weeks and slowly goes away. The muscle may become fibrotic but this may also disappear in initial five to eight months of life.
Acquired torticollis
This is due to injury to muscles or nerves. It is due to injury to neck, tumor at the base of the skull, a specific type of surgery for ear infection, nerve irritation due to infection of the posterior part of the pharynx and certain antipsychotic drugs.
Being women and family history of cervical distonia are the risk factors for cervical distonia.
Symptoms
Symptoms of wryneck are neck pain, headache, limited range of motion, head tremor, one shoulder is higher, chin straight up or down, chin or ear towards shoulder or swelling or stiffness of the neck muscle.
Signs and tests
Diagnosis of wryneck is done on the basis of history of birth, injuries, physical examination, neurological examination, examination of associated conditions, X-ray, electromyography, MRI (Magnetic resonance imaging) and blood or urine tests (for presence of toxins). Opthalmological examnation is also required to check for any vision problems.
Treatment
Congenital muscular torticollis
The condition may be treated by physical therapy or surgery. Physical therapy includes stretching, strengthening exercise and handling to encourage symmetry.
Changing the position in supine position is helpful. Giving plenty of tummy time when awake is also helpful.
Other treatments are low impact exercise, extended heat application, chiropractic correction of neck or repetitive shiatsu massage. If all methods of treatment fail then surgery can be done.
Acquired torticollis
Traction or surgery are the treatment options depending on the cause of acquired torticollis.
Medications used for the treatment of wryneck are drugs used in Parkinson’s disease, muscle relaxants or botulinum toxin.
Deep brain stimulation is also a treatment modality used for the treatment of cervical distonia.
Taking rest and reducing stress can help in minimizing the effects of cervical distonia.
Expectations (Prognosis)
The condition is easy to treat in infants and children. If the condition becomes chronic then there may be tingling or numbness due to compression of the nerve roots. Botulinum toxin gives relief.
Complications
Infants with wryneck are at increased risk of plagiocephaly. There may be muscle swelling or compression of nerve root and neurological symptoms or depression.
Calling your health care provide
If the symptoms of wryneck do not subside by treatment or any new symptoms develop then one must call the health care provider.
Prevention
Wryneck can not be prevented; treatment in early stages can prevent worsening of the condition.
Reference
Nih.gov, wikipedia.com, mayoclinic.com