ChiroACCESS Clinical Review



Acute Juvenile Cervical Torticollis: Diagnosis

This information is provided to you for use in conjunction with your clinical judgment and the specific needs of the patient.

Lead Author(s): 

Dwain M. Daniel, D.C.

  

How this evidence was rated:

Strength of Recommendation Taxonomy (SORT)



Published on

May 13, 2009

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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” (1). 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 (2), bacterial meningitis (3), fracture (4;5), neoplasm (6) and cervical dystonia (7). The scientific literature also has several different terms to describe variations of torticollis. Among these are atlantoaxial rotary subluxation (AARS) (8), atlantoaxial rotary fixation (AARF) (8), acquired torticollis (9), inflammatory torticollis (1), acute torticollis (10), Grisel’s syndrome (11) and muscular torticollis (MT) (12).

After more serious pathology has been ruled out the reader should be aware of AARF which often presents as a simple MT. AARF is a relatively rare, poorly understood, but potentially serious form of torticollis. Just as in MT, response to treatment is usually rapid. However if response is delayed, the outcome can result in long term symptoms (13;14) and may require surgical intervention. Karkos et al in their systematic review stated 15% of these patients may develop significant neurological sequelae (11).

Grading of AARF (15)

Type 1:  Rotary fixation without anterior displacement
Type 2:  Rotary fixation with anterior displacement of 3 to 5 mm (in the adult)
Type 3:  Rotary fixation with anterior displacement of over 5 mm
Type 4:  Rotary fixation with posterior displacement

It should be noted all the evidence for AARF or MT is based on case studies or case series. There are no RCT’s or case controlled studies available.


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References

1. 

Bredenkamp JK, Maceri DR. Inflammatory torticollis in children. Arch Otolaryngol Head Neck Surg 1990 Mar;116(3):310-3.



2. 

Harries PG. Retropharyngeal abscess and acute torticollis. J Laryngol Otol 1997 Dec;111(12):1183-5.



3. 

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5. 

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8. 

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11. 

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13. 

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16. 

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18. 

Grogaard B, Dullerud R, Magnaes B. Acute torticollis in children due to atlanto-axial rotary fixation. Arch Orthop Trauma Surg 1993;112(4):185-8.



19. 

Battiata AP, Pazos G. Grisel's syndrome: the two-hit hypothesis--a case report and literature review. Ear Nose Throat J 2004 Aug;83(8):553-5.



20. 

Scapinelli R. Three-dimensional computed tomography in infantile atlantoaxial rotatory fixation. J Bone Joint Surg Br 1994 May;76(3):367-70.



21. 

Maigne JY, Mutschler C, Doursounian L. Acute torticollis in an adolescent: case report and MRI study. Spine 2003 Jan 1;28(1):E13-E15.



22. 

Nicholson P, Higgins T, Forgarty E, Moore D, Dowling F. Three-dimensional spiral CT scanning in children with acute torticollis. Int Orthop 1999;23(1):47-50.



23. 

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24. 

Sobolewski BA, Mittiga MR, Reed JL. Atlantoaxial rotary subluxation after minor trauma. Pediatr Emerg Care 2008 Dec;24(12):852-6.