Acute Juvenile Cervical Torticollis: Diagnosis [Clinical Review]

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.