Paediatric Acute care Guidelines PMH Emergency Department
  • The term torticollis (or wry neck), from the Latin for “twisted neck”, refers to a characteristics position where the head is held tipped to one side with the chin rotated toward the other
  • It is a physical sign, not a condition, and can be caused by a wide range of problems

Background

Can be divided into 2 groups:

1. Torticollis Present at Birth

Muscular torticollis:

  • Due to fibrosis and shortening of one of the sternocleidomastoid muscle, secondary to either abnormal intrauterine positioning of the head or birth trauma
  • In birth trauma, bleeding into the body of the muscle causes a  which can be seen and felt (sternomastoid “tumour”) which undergoes fibrosis and shortening, resulting in the typical head position
  • Treatment usually involves physiotherapy with gentle passive stretching exercises and positioning of the baby in their cot to encourage looking toward the affected side
  • Rarely surgical release is necessary to prevent secondary plagiocephaly

Congenital vertebral abnormalities:

  • In cases where birth trauma was unlikely and not sternomastoid mass can be felt, cervical spine X-Rays (AP and lateral) should be done to look for bony abnormalities before any manipulation is done
2. Torticollis in a Previously Unaffected Child
  • Most cases are benign caused by by minor muscle trauma, or inflammation and spasm secondary to a nearby inflammatory process
  • Trauma may have been so minor that a particular event may not be recalled.  More significant trauma may result in subluxation, dislocation or fracture of cervical vertebrae, or fracture of a clavicle 
  • If history of significant trauma, immobilise in C-spine hard collar – see Cervical Spine Trauma guideline
  • Any inflammatory process in the area can cause torticollis, including URTI’s, cervical lymphadenitis, dental abscess, retropharyngeal abscess, or upper lobe pneumonia
  • Dystonic drug reactions may sometimes present as torticollis
  • An uncommon, but serious cause of torticollis is a tumour of the posterior fossa or spinal cord – perform a full neurological examination

Assessment

Investigations

  • If infective or inflammatory thought to be unlikely or if their is a history of trauma, cervical spine X-Rays should be taken
  • Neurological examination should be performed

Management

  • Muscular torticollis in infants can be managed with physiotherapy
  • Where minor trauma or muscular spasm is thought to be the cause, the patient can be treated symptomatically (analgesic and anti-inflammatory –  e.g. Ibuprofen) and followed up by GP
  • Infection should be treated with appropriate antibiotics if thought to be bacterial +/- referral to specialist team (e.g. ENT)
  • If no cause found, treat symptomatically but will require close follow up

Nursing

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