Acute Juvenile Cervical Torticollis

Return to Clinical Care Overview

Overview

Review Sections

(19)

Acute Juvenile Cervical Torticollis

Acute juvenile cervical torticollis is a descriptive term that encompasses several different diagnoses. Some of the causes of torticollis are life threatening or can lead to long term morbidity. A thorough examination is necessary to rule out serious pathology. The clinical reviews will primarily discuss the potentially serious condition atlantoaxial rotation fixation (AARF) and the relatively benign muscular torticollis (MT). Both conditions typically resolve quickly, however the physician must be aware if AARF is slow to respond to treatment possible serious sequela are possible. According to Roche et al if an AARF is detected and resolved within 1 month the prognosis is good and after 1 month it is guarded. Cervical fusion is recommended when there is neurological involvement, anterior displacement of C1 on C2, failure to achieve correction and presence of AARF for over 3 months (1).

(1) Roche CJ, O'Malley M, Dorgan JC, Carty HM. A pictorial review of atlanto-axial rotatory fixation: key points for the radiologist. Clin Radiol 2001 Dec;56(12):947-58.

Clinical Reviews

Acute Juvenile Cervical Torticollis: Prevention

A common presentation of acute juvenile cervical torticollis (AJCT) in the chiropractor’s office is a young patient experiencing a painful sternocleidomastoid (SCM) spasm of short duration which usually resolves rapidly after initiation of treatment. Cause of the spasm can be due to an atlantoaxial rotatory fixation (AARF), a potentially serious condition, or muscular and/or ligamentous etiology.

Acute Juvenile Cervical Torticollis: Diagnosis

Acute juvenile cervical torticollis (AJCT) is more of a descriptive term than a diagnostic term. For the purposes of this monograph AJCT will be used to describe the young patient that presents in acute pain with head tilt and cervical rotation that responds rapidly to care. The reader should be cautioned there are several variations of AJCT that can have life threatening or long term consequences. Bredenkamp and Maceri state “nearly 80 entities have been associated with torticollis”. Several of these entities, which may manifest as torticollis, represent serious conditions which must be ruled out. Just a few of the conditions which have been identified in the literature are retropharyngeal abscess, bacterial meningitis, fracture, neoplasm and cervical dystonia. The scientific literature also has several different terms to describe variations of torticollis. Among these are atlantoaxial rotary subluxation (AARS), atlantoaxial rotary fixation (AARF), acquired torticollis, inflammatory torticollis, acute torticollis, Grisel’s syndrome and muscular torticollis (MT).

Acute Juvenile Cervical Torticollis: Therapy

There are possible severe consequences for a missed or delayed diagnosis in acute juvenile cervical torticollis (AJCT). The ability to eliminate other causative factors and to distinguish between atlantoaxial rotation fixation (AARF) and simple muscular torticollis (MT) is of paramount importance.

Medical Subject Heading (MeSH) Information

MeSH Term: Torticollis

Scope Note: A symptom, not a disease, of a twisted neck. In most instances, the head is tipped toward one side and the chin rotated toward the other. The involuntary muscle contractions in the neck region of patients with torticollis can be due to congenital defects, trauma, inflammation, tumors, and neurological or other factors.

MeSH Synonyms:

Torticollis
Wryneck
Spasmodic Torticollis
Torticollis, Spasmodic
Cervical Dystonia
Torticollis, Psychogenic
Psychogenic Torticollis
Torticollis, Intermittent
Intermittent Torticollis

Applicable MeSH Subheadings:

analysis
anatomy and histology
blood
cerebrospinal fluid
chemically induced
classification
complications
congenital
cytology
diagnosis
drug therapy
economics
embryology
enzymology
epidemiology
ethnology
etiology
genetics
history
immunology
metabolism
microbiology
mortality
nursing
organization and administration
pathology
physiology
physiopathology
prevention and control
psychology
radiography
radionuclide imaging
rehabilitation
statistics and numerical data
surgery
therapy
ultrasonography
urine
veterinary
virology

One-Click Literature Search

Torticollis AND Prevention

Torticollis AND Diagnosis

Torticollis AND Therapy

Informative Links

Current Clinical Trials Relating to Torticollis

ClinicalTrials.gov: Provides patients, family members, and members of the public easy and free access to information on clinical studies for a wide range of diseases and conditions.

Effects of Botulinum Toxin in Cervical Dystonia

(Status: Recruiting)

Is Home Positioning Time Associated With Torticollis Rate of Recovery?

(Status: Active, not recruiting)

Comparative Trial of Botox in the Management of Children With Congenital Muscular Torticollis

(Status: Withdrawn)

Evaluating the Impact of a New Complement to Physiotherapy Intervention for Positional Torticollis in Infants

(Status: Terminated)

Randomized, Double-Blind, Placebo-Controlled, Parallel, Group Dose-Response, Study of E2014 in Patients WIth Spasmodic Torticollis

(Status: Completed)

PurTox (Botulinum Toxin Type A) for the Treatment of Adult Onset Spasmodic Torticollis/Cervical Dystonia

(Status: Completed)

Identification of Optimal Stimulation Site for Cervical Dystonia Symptoms: An Exploratory Study

(Status: Recruiting)

Efficacy and Safety of Two Different Botulinum Toxin Type A Treatments for Moderate to Severe Cervical Dystonia

(Status: Terminated)

The Physiology of Tricks

(Status: Completed)

Botulinum Toxin Injection Efficiency

(Status: Active, not recruiting)

Effect of Botulinum Toxin Type A on Swallowing in Patients With Cervical Dystonia

(Status: Completed)

Comparison of Efficacy and Safety of Two Different Types of Botulinum Toxin Type A in Moderate to Severe Cervical Dystonia

(Status: Completed)

Study Comparing Short Term Efficacy of Dysport® and Dysport RU® to Placebo, and to Assess Efficacy and Safety of Dysport RU® of Subjects With Cervical Dystonia

(Status: Active, not recruiting)

Open-label Extension Study of AbobotulinumtoxinA (Dysport®) for the Treatment of Cervical Dystonia

(Status: Completed)

Randomized, Placebo-Controlled Study of AbobotulinumtoxinA (Dysport®) for the Treatment of Cervical Dystonia

(Status: Completed)

Double-Blind, Multicenter Study to Assess the Efficacy of Bilateral Pallidal Stimulation in Patients With Medically Refractory Primary Cervical Dystonia

(Status: Completed)

Study to Evaluate Safety, Efficacy of Botulinum Toxin Type A in Patients With Cervical Dystonia

(Status: Completed)

Deep Brain Stimulation to Treat Cervical Dystonia

(Status: Completed)

IncobotulinumtoxinA (Xeomin) Versus Placebo in the Treatment of Cervical Dystonia

(Status: Completed)

MDs on Botox Utility (MOBILITY)

(Status: Active, not recruiting)

20 Clinical Trials Returned

Acupuncture

(Acute Juvenile Cervical Torticollis: Therapy)

A case series of 18 patients, 3 which were under 18 years old, demonstrated improved range of motion after a single treatment. Acupuncture points used were on the ipsilateral hand of the side of....

Published On

May 21, 2009

Age

(Acute Juvenile Cervical Torticollis: Prevention)

Children have several anatomical differences from adults. It has been suggested by several authors the combination of ligamentous laxity, steeper dens facet angles and synovial folds between the....

Published On

April 15, 2009

Cervical Collar

(Acute Juvenile Cervical Torticollis: Therapy)

Most of the literature reports placing the patient, for 1 to 6 weeks, in either a soft cervical collar (1;10;11) or rigid cervical collar (5;7;12) after reduction of AARF. The literature is less....

Published On

May 21, 2009

Cervical Traction

(Acute Juvenile Cervical Torticollis: Therapy)

Simple traction in a variety of forms appears to be an almost universal intervention for both MT and AARF. Manual traction (1), mechanical traction (2) halter traction (3-5), skull traction (6),....

Published On

May 21, 2009

Clinical Signs

(Acute Juvenile Cervical Torticollis: Diagnosis)

According to most authors there is a distinction between AARF and MT arising from spasm of the sternocleidomastoid (SCM) (15;16). AARF is considered uncommon and has the potential for long term....

Published On

May 13, 2009

Cold Draft

(Acute Juvenile Cervical Torticollis: Prevention)

Spasm of muscular origin can be caused by sleeping under a ceiling fan or exposing the neck to a cold draft according to some experts. It is thought to trigger SCM spasm through activation of....

Published On

April 15, 2009

Emotional Overlay

(Acute Juvenile Cervical Torticollis: Prevention)

Some practitioners have noted a relationship between emotional stress and onset of AJCT (12).

Published On

April 15, 2009

History

(Acute Juvenile Cervical Torticollis: Diagnosis)

Subach et al reported 75% of patients in a retrospective study diagnosed with AARF had a recent history of upper respiratory illness, traumatic injuries or head or neck surgery (8).

Published On

May 13, 2009

Imaging

(Acute Juvenile Cervical Torticollis: Diagnosis)

When AARF is suspected plain film x-rays and follow-up CT scans within two weeks (22), if improvement is not rapid, are considered the standard of care (8). Due to patient non-compliance and....

Published On

May 13, 2009

Infection

(Acute Juvenile Cervical Torticollis: Prevention)

Subach et al also stated 35% of the patients in their study had a history of recent infectious illness to include pharyngitis, otitis media and viral upper respiratory infection (8). This....

Published On

April 15, 2009

Manipulation Under Anesthesia

(Acute Juvenile Cervical Torticollis: Therapy)

Two case studies reported improvement in 2 patients with AARF that did not respond to conservative treatment (19;26).

Published On

May 21, 2009

Other Interventions

(Acute Juvenile Cervical Torticollis: Therapy)

Several other interventions have been reported. These include moxibustion (21), electrotherapy (22) infrasonic sound therapy (18) and spray and stretch (23).

Published On

May 21, 2009

Pharmaceuticals

(Acute Juvenile Cervical Torticollis: Therapy)

Use of muscle relaxants and anti-inflammatory medication are a common intervention for AARF. These are given intramuscularly (1), intravenously (4) and orally (10).

Published On

May 21, 2009

Spinal Instability

(Acute Juvenile Cervical Torticollis: Prevention)

Karkos et al reported in their 2007 systematic review that any syndrome associated with spinal instability places the patient in a high risk group. These conditions included Down’s syndrome,....

Published On

April 15, 2009

Spinal Manipulation

(Acute Juvenile Cervical Torticollis: Therapy)

Spinal manipulation has been reported as a treatment method for AJCT. Although most published evidence in the literature is limited to adult cases (13-15), there is one published case report of a....

Published On

May 21, 2009

Sudeck's Sign

(Acute Juvenile Cervical Torticollis: Diagnosis)

Although the confirming evidence in the literature is lacking, Sudeck’s sign is considered pathognomonic or at least strongly indicative of AARF by some experts (18). This sign is described....

Published On

May 13, 2009

Surgery

(Acute Juvenile Cervical Torticollis: Therapy)

Surgical intervention (5;12;27) is limited to those patients with AARF who do not respond to conservative or pharmaceutical care. Subach et al reported of 15 patients in their case series, 1....

Published On

May 21, 2009

Traction

(Acute Juvenile Cervical Torticollis: Therapy)

Although halter traction and mechanical traction are usually utilized (4;12;24) for AARF, caliper and halo traction use has also been reported (5;25).

Published On

May 21, 2009

Trauma

(Acute Juvenile Cervical Torticollis: Prevention)

Trauma has been reported as an initiating factor in AARF (7). In a small observational study Subach et all reported 20% of AARF patients had a history of trauma (8).

Published On