Torticollis is a twisting of the neck that can have many causes. In newborns, it is often due to issues during birth or position in the uterus. Older children may experience torticollis after neck injuries or infections. Treatment depends on the underlying cause but may include stretching, medication, bracing, or surgery. Imaging like ultrasound, CT, or MRI can help identify conditions like muscle issues, infections, fractures, or tumors that are causing the neck twisting.

3. Torticollis
DR/ MAHMOUD SALAMA
2016
QENA FEVER, GIT AND HEPATOLOGY HOSPITAL

5. Introduction: What is Torticollis?
• Derived from the
Latin: tortus
(twisted) + collis
(neck or collar)
• Torticollis is a
symptom related
to turning or
bending of the
neck.

6. Introduction
• Many different causes are possible.
• In newborns, Torticollis usually results from
injury during labour and delivery or the
infant’s position in the utreus. Less often, it is
caused by birth defects.
• In older children, torticollis may result from
injuries to the neck muscles, common
infections, or other causes.

7. Introduction
• Torticollis refers to a symptom rather than a
distinct disease process
• It can be caused by a wide variety of
conditions (over 80 causes have been
described) which range from relatively simple
self limited to life-threatening
• May be congenital or acquired
• Occurs more frequently in children than in
adults
• The right side is affected in 75% of patients

8. What does it look like?
• Abnormal twisting of the neck. Usually, child’s
head is tipped toward one side, with the chin
pointing in the other direction.
• Painful spasms of the neck muscles may occur.
• Other symptoms may be present, depending
on the cause.
• For example, there may be a tender lymph
node (gland) if the cause is infection.

10. Causes of Torticollis

11. 1. Congenital muscular torticollis
2. Acquired torticollis

12. Congenital muscular torticollis (CMT)
• CMT refers to muscular disorders causing
torticollis at birth or shortly after due to
unilateral shortening of the
sternocleidomastoid muscle.
• More common in males and on the right side.
• The affected muscle develops fibrotic changes
which can be associated with a mass
(fibromatosis colli) or without a mass

13. Congenital muscular torticollis
• Presentation is usually during the first 4
weeks of life with torticollis and / or
nontender neck mass.
• Thought to be caused by intrauterine
and perinatal events. Risk factors for CMT
include overcrowding environments
,first-born, oligohydramnios, breech
presentation and difficult delivery.

14. Congenital muscular torticollis
Ultrasound (US) is the imaging modality of
choice for initial investigation.
• There is diffuse or focal enlargement of the
sternocleidomastoid muscle.
• Focal mass is usually hypoechoic and
homogenous (fig 3).
• The mass usually resolve within the first year
of life with conservative treatment.

15. Congenital muscular torticollis
• the condition is treated with physical
therapies, such as stretching to release
tightness, strengthening exercises to improve
muscular balance, and handling to stimulate
symmetry.
• A Collar is sometimes applied.
• About 5–10% of cases fail to respond to
stretching and require surgical release of the
muscle.

16. 2- Acquired torticollis

17. Acquired torticollis
the most common etiologies
1. self-limiting
2. Trauma,
3. infections
4. inflammatory conditions,
5. central nervous system tumors or lesions

18. 1- self-limiting
• A self-limiting spontaneously occurring
form of torticollis with one or more
painful neck muscles is by far the most
common ('stiff neck') and will pass
spontaneously in 1–4 weeks.
• Usually the sternocleidomastoid muscle or
the trapezius muscle is involved.
• colds or unusual postures are implicated;
however in many cases no clear cause is
found.

19. 2- Trauma
• Occipital condyle fracture and facet dislocation
may present with torticollis
• Atlanto-axial rotatory fixation (AARF) of C2
• Spontaneous spinal epidural hematoma is a
rare disorder which might manifest with painful
torticollis followed by weakness and sensory
loss and is mostly common at the cervico-
thoracic level
• Subarachnoid hemorrhage

20. Trauma
• CT is the modality of choice in most
trauma cases.
• MRI is indicated in any case of
concern for ligamentous injury or
when there is a neurologic deficit.

21. 3- Infection and inflammation
• Head and neck and spinal column
infections may cause torticollis either
by muscular or ligamentous irritation
or from direct spinal disease.

22. Infectious and Inflammatory Causes of
Torticollis
• CNS related
– Meningitis
• Head and Neck related
– Upper respiratory infections
– Otitis media
– Mastoiditis/Bezold’s abscess
– Cervical adenitis
– Retropharyngeal abscess
• Spine related
– Vertebral osteomyelitis and/or discitis
– Epidural abscess
– Rheumatoid arthritis

23. Infection
• Lateral neck X RAY radiograph will show
increased soft tissue thickness anterior to the
C spine in retropharyngeal abscess
• US may show superficial lymphadenitis and
abscess.
• CT is used to visualize the deep neck spaces
and for pre-surgical planning.
• MRI is useful in spinal column infections due
to its increased sensitivity and its ability to
show soft tissue and epidural extension

24. Infectious Causes of Torticollis:
Mastoiditis/Bezold’s Abscess

25. 4- Tumors
• Tumors of the CNS, spine and neck may cause
torticollis
• • CNS tumors are usually in the posterior fossa
or C spine.
• The common presentation of C spine tumor is
pain due to dural irritation.
• Posterior fossa tumors ( CERBELLAR tumor)
may also have signs of increased intracranial
pressure.

26. 4- Tumors
• In any case of insidious development
of torticollis the possibility of a
tumor should be considered.
• MRI is the imaging modality of
choice

27. Other causes
• The use of certain drugs, such as
antipsychotics , Antiemetics ,
Neuroleptic Class and
Phenothiazines , can cause torticollis.

28. Treatment:
• Treatment for torticollis depends on
the cause:
• For newborns with torticollis, gentle
motion of the head and neck is
recommended to stretch the
muscles. Often, a physical therapist is
involved. To avoid injury, this should
be done only as recommended by a
doctor.

30. • For older children with torticollis related
to infection or inflammation, treatment
may include:
• Antibiotics for the specific infection.
• Rest.
• Anti-inflammatory medications (such as
ibuprofen).
• Passive motion to keep the muscles from
getting stiff.
• Surgery if indicated

31. • If the cause is related to trauma
(even sleeping position) treatments
may include:
• Muscle relaxants - Valium (generic
name: diazepam) and Passive
motion.
• A soft collar or brace to support the
neck.

33. Conclusion
• Torticollis is a clinical sign that might signify
an underlying disorder.
• In newborn infants with CMT, ultrasound is
preferred and often diagnostic.
• In older children CT is used to diagnose
traumatic insult, neck infection and vertebral
anomalies.
• MRI is used to diagnose inflammatory and
infectiouc spinal disorders and in cases in
which CNS or neck malignancy is suspected.