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19. torticollis

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Tehreem Anis
Tehreem Anis

Torticollis is a condition where the head is tilted to one side and the chin points to the opposite side, causing the neck to twist in an asymmetrical appearance. It is caused by an imbalance in the sternocleidomastoid muscle. Symptoms include a stiff neck, limited range of motion, and for infants, tilting of the chin. Treatments include physical therapy like stretching and massage to improve range of motion, NSAIDs or muscle relaxants for pain relief, and in severe cases, Botox injections or surgery may be used. The goal of physical therapy is to improve head and neck mobility and positioning.

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Torticollis Dr. Tehreem Anis DIRS, DU
Introduction  Also known as Wryneck  Head and chin are tilted at opposite angles, causing head to twist ◦ Asymmetrical Appearance  Effected Muscle: Sternocleidomastoid 2
3
4
Causes  Not well understood  Common causes: ◦ Developmental disorders affecting sternocleidomastoid muscle ◦ Imbalance in function of cervical muscles ◦ Other abnormalities in skull/cervical area 5
Other Causes  Genetic defect  Infants position during pregnancy or delivery  Tumors in head or neck  Arthritis of neck  Certain medications  Genes ◦ More likely to be affected if family member had torticollis or similar disorder 6
Symptoms  Adults and Children: ◦ Abnormal contraction of the neck ◦ Limited range of motion ◦ Stiff neck muscles ◦ Possible swelling and pain
Symptoms  Infants: ◦ Tilting of chin ◦ Small mass (pseudotumor) in neck ◦ Small neck spasms  Diagnosed before 1 month old = shorter physical therapy 8
Exams and Tests  Tests or procedures may be done to rule out possible causes of head and neck pain. A physical examination will show:  Head tilts toward the affected side while the chin points to the opposite side  Shortening of the neck muscles  The entire head pulls and turns to one side (in more severe cases)  Tests that may be done include:  CT scan of the neck  Electromyogram (EMG) to see which muscles are most affected 9
Treatments Medical treatment ◦ NSAIDS ◦ Muscle Relaxant ◦ Baclofen or Botox (Injection every three months) Physiotherapy measures Surgical management ◦ To release neck muscles ◦ For those patient who have a Risk of injury to spinal nerves
Physiotherapy Management Goals  Improve child's ability to turn head between right and left sides  Improve child's ability to bring chin to chest  Improve child's ability to orient their head to midline against gravity  Encourage child to lift head against gravity while lying on stomach  Allow child to experience proper weight shifting during developmental activities including sitting, rolling, creeping and walking
Physiotherapy measures  Heat therapy  Postural Training/Positional Training  Traction to the cervical spine  Massage  Stretching exercises  Neck braces  TENS
Side bending Rotation (head turning) Stretching
Positioning for Play Playing while lying on his side (side-lying) Playing on his stomach
Carrying Your Child Carry your baby like a football Put your baby on his/her tummy over your lap
Thank you 16

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19. torticollis

  • 2. Introduction  Also known as Wryneck  Head and chin are tilted at opposite angles, causing head to twist ◦ Asymmetrical Appearance  Effected Muscle: Sternocleidomastoid 2
  • 3. 3
  • 4. 4
  • 5. Causes  Not well understood  Common causes: ◦ Developmental disorders affecting sternocleidomastoid muscle ◦ Imbalance in function of cervical muscles ◦ Other abnormalities in skull/cervical area 5
  • 6. Other Causes  Genetic defect  Infants position during pregnancy or delivery  Tumors in head or neck  Arthritis of neck  Certain medications  Genes ◦ More likely to be affected if family member had torticollis or similar disorder 6
  • 7. Symptoms  Adults and Children: ◦ Abnormal contraction of the neck ◦ Limited range of motion ◦ Stiff neck muscles ◦ Possible swelling and pain
  • 8. Symptoms  Infants: ◦ Tilting of chin ◦ Small mass (pseudotumor) in neck ◦ Small neck spasms  Diagnosed before 1 month old = shorter physical therapy 8
  • 9. Exams and Tests  Tests or procedures may be done to rule out possible causes of head and neck pain. A physical examination will show:  Head tilts toward the affected side while the chin points to the opposite side  Shortening of the neck muscles  The entire head pulls and turns to one side (in more severe cases)  Tests that may be done include:  CT scan of the neck  Electromyogram (EMG) to see which muscles are most affected 9
  • 10. Treatments Medical treatment ◦ NSAIDS ◦ Muscle Relaxant ◦ Baclofen or Botox (Injection every three months) Physiotherapy measures Surgical management ◦ To release neck muscles ◦ For those patient who have a Risk of injury to spinal nerves
  • 11. Physiotherapy Management Goals  Improve child's ability to turn head between right and left sides  Improve child's ability to bring chin to chest  Improve child's ability to orient their head to midline against gravity  Encourage child to lift head against gravity while lying on stomach  Allow child to experience proper weight shifting during developmental activities including sitting, rolling, creeping and walking
  • 12. Physiotherapy measures  Heat therapy  Postural Training/Positional Training  Traction to the cervical spine  Massage  Stretching exercises  Neck braces  TENS
  • 13. Side bending Rotation (head turning) Stretching
  • 14. Positioning for Play Playing while lying on his side (side-lying) Playing on his stomach
  • 15. Carrying Your Child Carry your baby like a football Put your baby on his/her tummy over your lap