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PubMed1992

Reciprocal inhibition of forearm flexor muscles in spasmodic torticollis.

Reciprocal inhibition between forearm extensor and flexor muscles was tested by means of an H-reflex technique in patients with spasmodic torticollis and normal controls. In both, patients and controls three different phases of reciprocal inhibition could be demonstrated with maximal inhibition at conditioning test intervals of 0 ms, 15 ms and 100 ms, respectively. However, the quantitative amount of this inhibition was different for the patients and the controls. Significantly less inhibition was found for the second and the third phase of reciprocal inhibition in the patient group. Discriminant analysis showed a clear separation between normal subjects and patients if the amount of reciprocal inhibition of the second and third phase were taken into account. We were not able to detect any side differences neither for the patients nor for the controls. The findings demonstrate a functional disturbance of motor control mechanisms of a clinically unaffected extremity in spasmodic torticollis. This is believed to reflect a bilateral disturbance most likely within the basal ganglia or their outflow. Therefore, our data support the idea, that spasmodic torticollis is associated with or even due to a generalized rather than a focal disturbance of motor control mechanisms.

Analysis of Variance↗
PubMedDate not supplied

Ocular torticollis.

Torticollis can arise from nonocular (usually musculoskeletal) and ocular conditions. Abnormal head position for ocular reasons is usually assumed in order to maintain binocularity and/or to optimize visual acuity. A variety of conditions may be responsible. The sensory organ of position sense, the labyrinth, lies within the inner ear and it relates to eye movement in both a dynamic and static fashion. The Bielschowsky head tilt test is based on the functioning of the otolithic apparatus and is the primary test in evaluating abnormal head position. Treatment is usually surgical, with extent and location dependent upon on the underlying cause. While corrective surgery has usually been done on an elective basis for cosmetic purposes, there is evidence that uncorrected torticollis can cause musculoskeletal problems. This review describes the physiological bases for ocular torticollis and the diagnosis and treatment of its various underlying causes.

Apraxias↗
PubMed1986

Management of spasmodic torticollis.

Based on a review of the literature, the management of spasmodic torticollis may begin with the conservative measures of pharmacotherapy, sensory feedback, or percutaneous dorsal column stimulation. Approximately 50% of patients will benefit from an adequate trial of these modalities. With particularly resistant and disabling torticollis, the ablative procedures of microsurgical cervical rhizotomy or stereotaxic thalamotomy have offered significant relief in about 74% and 56%, respectively, of properly selected cases. Nevertheless, the variability in the duration of response to all forms of therapy has made the treatment of spasmodic torticollis a difficult and often frustrating undertaking.

Electric Stimulation Therapy↗
PubMed1996

Torticollis acquired in late infancy due to a cerebellar gangliocytoma.

Torticollis in infancy is a common disorder and is typically benign and self-limiting. However, in some instances it is the presentation of serious disease. A critical distinction is whether the condition is congenital or acquired. We present a case of acquired late infantile torticollis caused by a cerebellar gangliocytoma that underscores the importance of making this determination prior to initiating a treatment plan. A gangliocytoma presenting with torticollis has not been previously described.

Cerebellar Neoplasms↗
PubMedDate not supplied

Pressure-related torticollis: an unusual manifestation of pseudotumor cerebri.

A 9-year-old boy with pseudotumor cerebri who presented with neck pain and an accompanying torticollis is described. The patient exhibited bony abnormalities of the upper cervical spine and facial asymmetry that suggested a congenital torticollis. Reduction of the increased cerebrospinal fluid pressure by lumbar puncture resulted in a prompt and dramatic resolution of the cervical symptoms and signs. Increased cerebrospinal fluid pressure should be added to the list of those disorders that may give rise to reversible torticollis.

Cerebrospinal Fluid Pressure↗
PubMed1998

Psychiatric comorbidity in patients with spasmodic torticollis.

Several studies have reported raised levels of psychopathology based on self-rating scales in patients with spasmodic torticollis. Recent publications have also proposed that psychopathology, especially symptoms of depression, might be a reaction to dystonia or constitute a nonspecific reaction pattern. To determine the actual frequency of psychiatric disorders, we evaluated 44 patients with spasmodic torticollis (20 female, 24 male; mean age 43.6 years, SD 10.4) using the standard instrument for psychiatric diagnosis in the DSM-III-R (Structured Clinical Interview Schedule, SCID). The SCID permits retrospective diagnosis for most of the major psychiatric disorders, including the time before onset of dystonia. SCID criteria for at least one psychiatric disorder were fulfilled in 65.9% of patients, including both lifetime and current diagnosis. The most frequent diagnostic categories were panic disorder with or without agoraphobia (29.5%), major depressive disorder (25%), substance abuse (13.6%), and obsessive compulsive disorders (6.8%) were diagnosed less frequently. The patient-recalled onset of psychiatric symptoms preceded onset of torticollis symptoms in 43.2% of those investigated.

Adolescent↗
PubMed1979

Atlanto axial rotatory fixation--a cause of torticollis.

Atlanto-axial rotatory fixation is a rare but important cause of persistent torticollis. The diagnosis is confirmed by careful radiological examination of the atlanto-axial joint, also employing tomography if necessary. Treatment is skull traction in an attempt to improve the position followed by posterior atlanto-axial fusion to prevent further, and potentially disastrous, displacement. Atlanto-axial dislocation or subluxation should be looked for in all cases of acute torticollis, when reduction by traction will most likely be successful and prevent the development of atlanto-axial rotatory fixation and the associated persistent torticollis.

Atlanto-Occipital Joint↗
PubMed1997

Pain in spasmodic torticollis.

Spasmodic torticollis (cervical dystonia) is frequently a painful condition but little is known of the characteristics of the pain. We assessed 39 patients with spasmodic torticollis for the presence or absence, location, and quality of pain, as well as its correlation to postural abnormality. Muscle tenderness was evaluated by manual palpation and pressure algometry. Measurements were made on muscles either actively maintaining or opposing abnormal head posture, as well as on muscles not contributing to it. Control measurements were made in 18 healthy subjects. Two-thirds of patients reported continuous or intermittent recurrent pain. Pain was reported widespread and diffuse over the neck and shoulders, with some radiation, predominantly on the side toward which the head was twisted. There were no differences between study groups when compared for pressure algometry and only moderate differences when compared for manual palpation. No correlation was found between the severity of motor signs and pain. Degenerative changes seen on X-rays were similar in painful and pain-free patients. These findings suggest that pain associated with spasmodic torticollis does not arise in muscles alone, and we hypothesise that central mechanisms are also involved.

Adult↗
PubMed1998

The helical three-dimensional CT in the diagnosis of torticollis with occipitocondylar hypoplasia.

Congenital anomalies of the atlanto-occipital and atlantoaxial joints are rare. Those most commonly reported are atlantoaxial instability, basilar impression, anomalies of the odontoid process, laxity of the transverse atlantal ligament and atlanto-occipital fusion. Occipital condylar hypoplasia is infrequent and difficult to recognise. We recently diagnosed it using helical 3D CT in association with torticollis in two patients. The first patient had a several year history of torticollis. The second patient had acute cervical lymphadenitis associated with post-operative torticollis. 3D CT distinctly revealed atlantoaxial subluxation with hypoplasia of the occipital condyles in both cases.

Acute Disease↗
PubMed1999

Arteriovenous fistula: a cause of torticollis.

Torticollis is a symptom that may represent a wide spectrum of disorders ranging from a simple etiology to a life-threatening pathology. Pediatricians have to suspect central nervous system abnormalities whenever faced with torticollis. The authors report an arteriovenous fistula at the craniocervical junction in a patient presenting with torticollis.

Arteriovenous Fistula↗
PubMed1997

Retropharyngeal abscess and acute torticollis.

Acute torticollis may result from an inflammatory process irritating the cervical muscles. In children there is often an association between acute torticollis and retropharyngeal cellulitis/abscess. Over six weeks, two children with acute torticollis presented to our Department. Both children were found to have retropharyngeal cellulitis/abscess. The problem of differentiating between the non-suppurative and the suppurative phases of the disease process is discussed.

Acute Disease↗
PubMed2000

Congenital muscular torticollis: early and intensive treatment is critical. A prospective study.

BACKGROUND: Although the success of conservative management of congenital muscular torticollis has been well documented, relatively little is known about the determinants of this outcome, such as treatment duration and exercise frequency. The aim of the present study was to define factors related to treatment duration, to compare different frequencies and intensities of home treatment programs and their effect on the speed of recovery. METHODS: The present study was a prospective study of 45 infants (26 male, 19 female) with congenital muscular torticollis referred to the pediatric surgical outpatient during a I year period. Following a standardized initial assessment, parents were taught our intensive home treatment protocol, consisting of passive stretching exercises repeated every 3 h. RESULTS: The mean age at initial assessment was 38.6 days (range 15-120 days). Mean treatment duration was found to be 3.2 +/- 1.3 months. All patients were treated by use of our intensive protocol of passive stretching exercises (100% success). No surgery was necessary. CONCLUSIONS: In patients with early treated congenital muscular torticollis, there is no place for surgical treatment. This group of patients can be successfully treated using an intensive protocol of passive stretching exercises. In addition, this treatment protocol has a very short treatment duration compared with other standardized protocols. A successful outcome depends primarily on good cooperation with the parents, especially in developing countries.

Exercise Therapy↗
PubMed2000

The clinical presentation and outcome of treatment of congenital muscular torticollis in infants--a study of 1,086 cases.

BACKGROUND/PURPOSE: The main objectives of this study were to define the clinical patterns and characteristics of congenital muscular torticollis (CMT) presented in the first year of life and to study the outcome of different treatment methods. METHODS: This is a prospective study of all CMT patients seen in 1 center over a 12-year period with uniform recording system, assessment methods, and treatment protocol. RESULTS: From a total of 1,086 CMT infants, 3 clinical subgroups of sternomastoid tumor (SMT; 42.7%), muscular torticollis (MT; 30.6%), and postural torticollis (POST; 22.1%) were identified. The SMT group was found to present earlier within the first 3 months and was associated with higher incidence of breech presentation (19.5%), difficult labor (56%), and hip dysplasia (6.81%). Severity of limitation of passive neck rotation range (ROTGp) was found to correlate significantly with the presence of SMT, bigger tumor size, hip dysplasia, degree of head tilt, and craniofacial asymmetry. CONCLUSIONS: A total of 24.5% of the patients with initial deficits of passive rotation of less than 10 degrees showed excellent and good outcome with active home positioning and stimulation program. The remaining cases with rotation deficits of over 10 degrees and treated with manual stretching program showed an overall excellent to good results in 91.1% with 5.1% requiring subsequent surgical treatment. The most important prognostic factors for the necessity of surgical treatment were the clinical subgroup, the ROTGp, and the age at presentation (P < .001).

Age Factors↗
PubMed1996

Spontaneous torticollis in a breech-presenting fetus delivered by an atraumatic elective cesarean section: a case and review of the literature.

A non-laboring patient with a breech-presenting fetus and oligohydramnios at 41 weeks' gestation underwent elective cesarean delivery. The infant was delivered atraumatically through a wide transverse incision of the lower uterine segment. Severe leftsided torticollis was noted immediately at delivery. The torticollis subsequently responded to physiotherapy with minimal residual facial asymmetry. This case and the literature suggest that torticollis itself may predispose to breech presentation. Alternatively, in the case presented, oligohydramnios with subsequent restricted posture may have contributed to the underlying pathophysiology of this phenomena, which previously has been noted as associated with and as a possible sequela of traumatic vaginal breech delivery.

Adult↗
PubMedDate not supplied

[Subcutaneous tenotomy of the sternocleidomastoid muscle as therapy in muscular torticollis].

This study reviews the cases of 49 patients with congenital muscular torticollis after an average follow-up of seven years, who were treated with subcutaneous sternomastoid tenotomy. An excellent result was found in 18 patients (37%), a good result in another 18 patients (37%), while the result of 13 patients (26%) must be regarded as unsatisfactory. There were no severe complications to be seen. These results are compared with other operative technics of treatment of muscular torticollis and the poor results are analyzed. We believe that subcutaneous sternomastoid tenotomy is a good method for treatment of muscular torticollis, with the advantage of avoiding any ugly scar.

Adolescent↗
PubMedDate not supplied

[Acute torticollis and its roentgen analysis].

It has hitherto been assumed without exception that A-P films of acute torticollis demonstrate neither malposture nor subluxation or (worse still) luxation of the atlas. In contrast, there is ventral subluxation of the atlas in all cases, although in about one-half of them this only become manifest in ventral flexion, with a tendency to form an angle between the odontoid process and the first cervical vertebra. In conformity with the head posture in acute torticollis, X-ray findings in the head joints are normal on A-P films. Fundamental to acute torticollis is that when the head is held in certain positions -- lateral inclination with rotation, sometimes combined with tilting of the head -- spontaneous, occasionally gradual obstruction of rotation of the atlas (and more rarely of the axis) occur; as a result, the head has to be held in these positions by force. In attempts to equalize head posture temporarily, lateral shifting of the atlas quite frequently occurs; depending on atlas rotation and the statics of the cervical spine, it may be either physiological or pathologic.

Acute Disease↗
PubMed1987

[Torticollis--a harmless symptom?].

Acquired non-traumatic torticollis may be due to a variety of causes. Presumably it may arise from inflammatory diseases and tumours of the neck as well as the central nervous system. Three cases of acquired torticollis due to osteomyelitis, retropharyngeal carcinoma and subluxation of the spine are presented and the variety of possible underlying diseases is demonstrated. Persistent torticollis should provoke an aggressive search for a specific aetiology by all means, especially CT scans or even biopsy.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Torticollis and plagiocephaly in infancy: therapeutic strategies.

BACKGROUND: Asymmetry in infancy is a diagnosis with a large spectrum of features, expressing an abnormal shape of parts of the body or unequal postures and movements, which might be structural and/or functional, with localized or generalized expression. PURPOSE: The purpose of the present study is to highlight different therapeutic aspects of the most occurring asymmetries in infancy: congenital muscular torticollis, positional torticollis and plagiocephaly, based on best evidence in current literature. RESULTS: A flow chart is presented showing different pathways in therapeutic strategies, such as physical therapy, orthotic devices (helmet treatment and Dynamic Orthotic Cranioplasty) and surgery. CONCLUSION: It is concluded that there are different views towards management on torticollis and plagiocephaly. A systematic therapeutic management to evaluate these asymmetries is indicated. The presented therapeutic flow chart might serve as a basis in order to achieve uniformity in therapeutic thinking and performance.

Craniosynostoses↗