Torticollis - wry neck

CLinfant torticollisTHUMBTorticollis represents one-sided muscle crick in the nape, involved into the group of dystonic syndromes (characterised with sudden uncommon changes in the muscle tone: unwanted movements, muscle tension, twitching, tremors…). It is often a congenital defect, which is caused by shortening of the muscle - sternocleidomastoid muscle and upper parts of the trapezius muscle. Less common is a form acquired from inflammation in the neck area, blockages in the area of cervical spine, injuries of the cervical spine, or from central nervous system diseases. The most common cause is a disorder of the unwanted muscle activity of unknown cause, so called idiopathic form.

DIAGNOSTICS IN PRACTICE

Diagnosis of the cervical dystonia (torticollis spastica) is not usually difficult in most cases. We are judging so by a clinical finding of usually permanently twisted neck and head into a certain direction. It is important to examine the range of mobility, that is where we usually find significant movement restriction to the side. The effort for passive deviation in this area is usually unsuccessful and the patient feels pain. We can also examine patient by touch, we feel significantly increased pathological tension in the neck muscles causing the head to bend to the side.

PROCESS OF THE DISORDER

Disorder of idiopathic cervical dystonia has a slower start. The sensation of tension behind neck is later changing in a pain as a result of physical activity. In further stages the pain remains during the whole day, that is when the patient starts bending the neck to one side unconsciously (usually it is noticed by people around first).

TREATMENT

The therapy of muscle spasms is from neurological point of view resistant against medicament treatment. But many medicaments are still being used. In the past the disorder was usually treated with surgical solution, unfortunately with almost no positive effect. Nowadays the goal of the treatment is to reach the best possible relief for the affected muscles. That enable the antagonistic muscles (muscles with opposite movement function) with compensation mechanism to turn the neck back into natural position. But patient has to use botulotoxin A during the therapy.

By using special physiotherapeutic methods you can train the correction mechanism to improve the abnormal position of the neck and head with an intentional movement, so that you would be able to place your head into a straight position and stay in it. Regular physiotherapy can prolong and also lower the dosage of botulotoxin. By us at FYZIOklinika you can use the option of radial shock wave therapy to get rid of the pain from the affected muscle groups. Application of focused shock wave therapy also represents an option of how to get rid of pain, spasm and inflammatory reactions in the tissue. So there is an existing alternative between physiotherapy and physical therapy, thanks to which you can lower the need to use medical treatment.



Author:
FYZIOklinika physiotherapy Ltd., Prague, Czech Republic

Source: M. Bareš et. all, 2007, Cervikální dystonie, Cesk Slov Neurol N 2007

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