Torticollis (torticollis) in adults

Torticollis, or torticollis, is a group of diseases in which a characteristic deformity of the neck is observed. The patient’s head is constantly tilted to the sick side and turned to the healthy side. The disease is more common in newborns but can also occur in adults. There are several types of torticollis, each of which has its causes. Let’s talk about torticollis in adults: what forms it has, how it manifests, and whether it is treated.

Forms of torticollis and classification by reason

Torticollis is congenital and acquired. If torticollis is formed in the fetus even during the prenatal period, the child is already born with characteristic symptoms.

Congenital torticollis

There are the following forms of the disease:

• Idiopathic. It is manifested by a slight head tilt without any changes in the anatomical structures of the neck. In particular, the length and thickness of the sternocleidomastoid (sternocleidomastoid) muscle have not changed in idiopathic torticollis. The exact causes of the formation of pathology have not been established. It was revealed that this form of the disease, as a rule, occurs during a difficult course of pregnancy and childbirth and often accompanies perinatal damage to the CNS of a hypoxic nature.
• Myogenic. It is detected more often than other forms of the disease. With congenital muscular torticollis, one-sided compaction and shortening of the sternocleidomastoid muscle are observed. Myogenic torticollis is formed in the pathological position of the fetus, as a result of which the head of the child is forced to lean towards the shoulder for a long time.
• The pediatrician easily detects unilateral changes in the muscles of the neck during examination and palpation. Passive movements on the affected side are painful.
• Congenital muscular torticollis needs prompt treatment. Left unattended, it leads to such serious consequences as the curvature of the spine, defects in the structure of the skull, improper development of the muscles of the shoulder girdle, and pronounced asymmetry of the face.
• Neurogenic. Serves as a manifestation of unilateral muscular dystonia. Neurogenic torticollis is combined with a characteristic change in the state of the muscles on the side of the lesion: trunk curvature, leg flexion, and hand clenching.
• Osteogenic. It is a consequence of a congenital disease – Klippel-Feil disease. In this case, decreasing the vertebrae or their cohesion leads to a characteristic neck deformation. Osteogenic torticollis is often associated with other developmental disorders of the musculoskeletal system.

Congenital torticollis has a good prognosis: with correct and timely medical intervention, the pathology has no consequences for adult patients. The only exception is Klippel-Feil disease, the manifestations of which can only be compensated to a certain extent.

Acquired torticollis

Symptoms of torticollis can occur in adults and children for several reasons. Acquired forms of torticollis include:

• Spastic (cervical dystonia) is a chronic lesion of the central nervous system, accompanied by spontaneous spasms of the cervical muscles. In this case, the patient develops a periodic or constant deviation of the head to one side.
• Installation – observed in newborns and infants with a long fixed position in the womb, a crib, or cradle.
• Compensatory, the development of which can provoke strabismus and labyrinthitis – an inflammatory disease of the inner ear. The forced tilt of the head in the first case makes it possible to expand the field of view and, in the second case – to reduce the intensity of dizziness.
• Reflex – can be observed due to the inflammatory process in the neck (abscesses, myositis), as well as with otitis media and mastoiditis.
• Acute trauma, the cause of which is a fracture of the first vertebra. This form of torticollis is accompanied by severe pain at rest and on palpation and limitation of both active and passive movements in the cervical spine. The bulbar syndrome may also develop, manifested by a violation of speech and swallowing function.
• Acute torticollis can also form due to subluxation of the first vertebra. Such an injury is often the result of a sharp, careless turn of the head when performing manual manipulations, sports exercises, or household work.
• Infectious, which develops in some patients with bone tuberculosis and osteomyelitis.

Other possible causes of the acquired form of the disease are large cicatricial deformities on the skin of the neck (dermatogenic form), neoplasms of the spine, and progression of cerebral palsy. Finally, a form of torticollis is distinguished, which sometimes accompanies the course of hysterical psychosis.

Spasmodic torticollis

Let us consider in more detail such a type of acquired torticollis as cervical dystonia. This form of the disease – spastic torticollis – is more common in adults than in children. The onset of the disease occurs at 30-40 years old.

The exact causes of spastic torticollis have not yet been established. Emotional stress and head and neck injuries are considered the main provoking factors.

Turning the head around a horizontal axis in spastic torticollis is combined with dystonic tremor, as well as with pain in the neck and back of the head and shoulder region. Dystonia is aggravated in the vertical position of the body, with physical and psycho-emotional overwork.

Spasmodic torticollis has a subacute or gradual onset. As a rule, the disease’s progress is observed within 2-5 years, and then a period of plateau often occurs. Remissions last, on average, about six months.

Cervical dystonia limits the patient’s ability to work and perform everyday activities. The disease is often accompanied by phobias, depression, and anxiety disorder. The severity and severity of the manifestations of the disease stimulate the search for new methods of treatment of cervical dystonia.

When should you go to the doctor?

It is necessary to seek medical help if you suspect the presence of any form of torticollis. Torticollis, whatever it may be called, always requires correction. Pathological changes affect the anatomy of the neck – the link between the skull and spine, brain and spinal cord. Therefore, the consequences of neglecting medical care can be the most serious: cranial deformities, neurological disorders, cognitive decline (memory, attention), etc.

Diagnosis and examination

The diagnosis of torticollis in an adult is made by a doctor based on anamnesis and an objective examination of the patient. If any forms of the disease are suspected, an x-ray of the cervical spine is performed. Some targeted images of the first two cervical vertebrae are also performed.

Diagnosis and treatment of certain forms of acquired torticollis require consultations with doctors of narrow specialties. So, with compensatory torticollis, the patient should be examined by an ophthalmologist or ENT, with an infectious one with the possible presence of tuberculosis, by a phthisiatrician, and with hysterical, by a psychiatrist.

Therapy

Pediatric orthopedists treat patients with congenital torticollis. Treatment of the acquired form, depending on the cause, maybe the prerogative of neurologists, surgeons, exercise therapy doctors, etc. A promising area is the osteopathic treatment of torticollis in adults.

Muscular torticollis, both congenital and acquired, is treated with the following:

• Massage.
• Therapeutic physical education.
• Physiotherapeutic procedures (electrophoresis, UHF).

Surgery is performed in severe cases (if the affected sternocleidomastoid muscle is 40% shorter than the healthy one) or ineffectiveness of therapy. The neck is plastered for a month; then, the plaster is replaced with a Shants fixation collar.

With other types of acquired torticollis, the treatment of the underlying pathology, which led to the pathological tilt of the head, is carried out. In the recovery period, exercise therapy and massage are also prescribed to return to the fullness of movement in the cervical spine.

For treating spastic torticollis, botulinum therapy (Botox, Dysport injections), auxiliary medications, and physiotherapeutic methods are traditionally used. In some cases, surgery may be required.

Torticollis in adults and osteopathy

Osteopathic doctors consider the human body as a whole and perceive any disease in terms of its impact on all organs and systems, not on a specific anatomical area. Torticollis of any nature can lead to a serious imbalance of the musculoskeletal system, which can lead to neurological problems, respiratory failure, etc. Osteopathic treatment of acquired torticollis is carried out after the cause of the disease has been eliminated (by a specialized specialist or as a result of a surgical operation).

In many cases, osteopathic treatment can also address the cause of the disease if the root cause is some injury – not necessarily a neck injury. The root cause of torticollis can sometimes be a birth injury or an ankle sprain due to a sprained leg. The symptoms often appear not immediately but after several months or years.

Before starting therapy, the osteopathic doctor interviews the patient in detail examines him (attention is paid not only to the head and neck but also to all other anatomical areas), and gets acquainted with the results of previous studies and the treatment received. Based on the data obtained during osteopathic diagnostics, the specialist proceeds to the session.

The main tool of the osteopath is the hands. With the help of soft manual impact on the damaged areas, the specialist gradually restores mobility in the affected area and eliminates other problems associated with the underlying pathology. In addition to the osteopathic treatment of torticollis, kinesiotherapy (exercise therapy, AFC) is also used.