Acquired torticollis in children
- Charles G Macias, MD, MPH
Charles G Macias, MD, MPH
- Associate Professor of Pediatrics
- Baylor College of Medicine
- Vanthaya Gan, MD
Vanthaya Gan, MD
- Clinical Professor of Pediatrics
- University of Texas Southwestern Medical Center
- Section Editors
- Richard G Bachur, MD
Richard G Bachur, MD
- Section Editor — Pediatric Trauma
- Professor of Pediatrics and Emergency Medicine
- Harvard Medical School
- William Phillips, MD
William Phillips, MD
- Section Editor — Pediatric Orthopedics
- Professor of Pediatrics and Orthopedics
- Baylor College of Medicine
- Glenn C Isaacson, MD, FAAP
Glenn C Isaacson, MD, FAAP
- Section Editor — Pediatric Otolaryngology
- Professor, Departments of Otolaryngology, Head and Neck Surgery and Pediatrics
- Lewis Katz School of Medicine at Temple University
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Torticollis is the term for the clinical finding of a twisted or rotated neck. In Latin, the word "torus" means "twisted" and "collum" means "neck". Torticollis, also called wryneck, is a common complaint in children and may be congenital or acquired. Facial asymmetry is often present in children who have congenital torticollis, but rarely in those with acquired torticollis, and is sometimes used to distinguish the two types . Congenital torticollis is more common than acquired torticollis.
The causes, presentation, and evaluation of acquired torticollis will be reviewed below. Congenital muscular torticollis and evaluation of neck stiffness are discussed separately. (See "Congenital muscular torticollis: Clinical features and diagnosis" and "Approach to neck stiffness in children" and "Congenital muscular torticollis: Management and prognosis".)
Torticollis or wryneck refers to lateral twisting of the neck that causes the head to tilt to one side with the chin turned to the opposite side (figure 1). The sternocleidomastoid (SCM) takes origin from two tendons (one from the manubrium sterni and one from the medial third of the clavicle) that combine to form a single muscle bundle running in the neck superiorly and posteriorly to insert onto the ipsilateral mastoid process of the temporal bone and the superior nuchal line of the occipital bone. Central to many but not all cases of torticollis is shortening or spasm of a SCM muscle that causes the abnormal posturing with variable degrees of neck flexion or extension .
Describing a child as having a "left" or "right" torticollis can result in confusion among providers, since some may be referring to the pathologic SCM muscle and others to the direction in which either the head and ear is tilted or the chin is rotated. To avoid this, we recommend that torticollis be described in terms of the direction of both head and ear tilt AND chin rotation (eg, torticollis with head tilt to the left and chin rotation to the right (picture 1)).
Torticollis may occur in congenital and acquired forms:
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- LIFE-THREATENING CAUSES
- Retropharyngeal abscess
- Suppurative jugular thrombophlebitis (Lemierre syndrome)
- Cervical spine injury
- Spinal epidural hematoma
- Central nervous system tumor
- COMMON CAUSES
- Muscle injury or inflammation
- Acute infections
- Atlantoaxial rotary subluxation
- - Clinical manifestations and diagnosis
- - Management
- OTHER CAUSES
- Ocular torticollis
- - Spasmus nutans
- Benign paroxysmal torticollis
- Dystonic reaction
- Sandifer syndrome
- CLINICAL PRESENTATION AND APPROACH
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS