Torticollis

Involuntary contraction of neck leading to abnormal posture and movement of head is called Torticollis. It is not a diagnosis but a sign of underlying disorder.

Causes:

1.       Congenital

2.       Acquired

1.      Congenital:

·         Trauma (by birth) to sternocleiodomastoid

·         Spina bifida

·         Vertebral anomalies

·         Clavicle fracture

·         Arnold – chiari malformation (protrusion of lower brain stem and cerebellum through the opening for spinal cord at the base of the skull)

2.      Acquired:

o   Spasm of cervical muscles due to injury to muscles or nerves

o   Awkward position during sleep

o   Cervical spine trauma

o   Retropharyngeal abscess

o   Any infection involving surrounding tissue of neck

o   Drugs: Phenothiazines (piprazine), Metachlopromide

Diagnosis:

§  X – ray of neck

§  MRI/CT of spine

Management:

General:

·         Check airway

·         Patient with trauma stabilize neck

Remember: Cause identification is primary aim and then treatment accordingly.

Specific:

·         Benztropine

·         Benzodiazepine

·         Analgesics

·         Physiotherapy

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Neck Pain

Neck pain is less common than back pain and is significant problem in the elderly. It is more common in female than male. Most prolapse (70 %) affect the C6 disc, compressing the C7 root: 20 % affects C5.

Causes of Neck Pain:

a.      Mechanical:

·         Postural

·         Disc prolapse

·         Whiplash injury

·         Cervical spondylosis

b.      Inflammatory:

·         Rheumatoid arthritis

·         Spondylitis

·         Infection

·         Polymyalgia rheumatica

·         Juvenile idiopathic arthritis

c.       Metabolic bone diseases:

·         Osteoporosis

·         Paget’s disease

·         Osteomalacia

d.      Neoplasia:

·         Metastasis

·         Myeloma

e.       Referred pain:

·         Pharynx problems

·         Aortic aneurysm

·         Cervical lymph nodes

·         Myocardial infarction

·         Teeth pain

·         Angina pectoris

Sign and symptoms:

·         Pain: Pain is aggravated by turning head, up or down. The pain may radiate to the upper limb.

·         Limited cervical ROM

·         Stiffness of neck

·         Parasthesis due to Radicular pain

Investigations:

X – Ray:

o   To know osteophytes

o   Disc compression

MRI: Cervical spine

Treatment:

Non specific pain:

Analgesics

Physiotherapy

Cervical colar

Acute strain: (Musculo – tendinous)

Immobilization

Analgesic

Cervical colar

Physiotherapy

Herniated disc:

Cervical traction

Analgesic

Physiotherapy

Surgery

Arthritis:

DMARDs

Analgesics

Physiotherapy

Surgery

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