MANUAL MINORS
Acute torticollis is a condition characterised by involuntary and painful contraction of the neck muscles, resulting in an abnormal posture, typically with the head tilted to one side and limited neck mobility.
This condition is often caused by poor sleeping posture, sudden movements, muscle strain, or overuse of the neck muscles. It is more common in young adults and is generally self-limiting.
Diagnosis
Diagnosis of acute torticollis is clinical and based on the typical presentation of acute neck pain and stiffness, with the head tilted to one side and difficulty moving it.
Patients typically experience pain when trying to turn or tilt the neck in the opposite direction. Imaging studies are not required in typical cases, but persistent cases or those with suspected other causes (trauma, infection) may warrant X-rays or magnetic resonance imaging (MRI) to rule out other pathologies.
Differential Diagnosis
Pathology | Characteristics |
|---|---|
Cervical sprain | Neck pain following trauma, with restricted movement |
Cervical disc herniation | Neck pain radiating to the arm, with neurological symptoms (tingling, weakness) |
Myositis | Muscle pain from inflammation, without characteristic head tilt |
Spasmodic dystonia | Abnormal, repetitive muscle contraction of the neck |
Brachial plexus injury | Pain and arm weakness, generally following trauma |
Emergency Management
Emergency management of acute torticollis focuses on relieving pain and relaxing the muscles. Non-steroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants are administered to reduce spasms. Local heat application is helpful to relax the affected muscles.
In some cases, gentle massage and gradual neck mobilisation may provide relief. If pain is severe or persistent, local injections of lidocaine or corticosteroids can be considered.
Definitive Treatment
Definitive treatment is usually conservative. Most cases of acute torticollis resolve spontaneously within a few days. Resting the neck, avoiding sudden movements, along with the use of analgesics and muscle relaxants, is typically sufficient.
Gentle stretching exercises and physiotherapy can help prevent recurrence. For recurrent or persistent cases, further evaluation may be needed to rule out underlying causes.
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