Background
Torticollis is the common term for various conditions of head and neck dystonia, which display specific variations in head movements (phasic components) characterized by the direction of movement (horizontal, as if to say “no”, or vertical, as if to say “yes”). Such to-and-fro movements of the head can be equal (as in a tremor) or unequal (ie, rapid clonic movements of the head and neck with slow recovery, termed spasmodic). Torticollis is derived from the Latin, tortus, meaning twisted and collum, meaning neck.
Torticollis results in a fixed or dynamic posturing of the head and neck in tilt, rotation, and flexion.
Spasms of the sternocleidomastoid, trapezius, and other neck muscles, usually more prominent on one side than the other, cause turning or tipping of the head.
Note the images below.
Female patient presenting with torticollis. Image courtesy of Danette C Taylor, DO, MS.
Female patient presenting with torticollis. Image courtesy of Danette C Taylor, DO, MS.
Female patient presenting with torticollis. Image courtesy of Danette C Taylor, DO, MS.
Characteristic head tilt often occurs from a tonic component. One example is laterocollis, in which the head is displaced with the ear moved toward the shoulder from increased tone in the ipsilateral cervical muscles. Another is rotational torticollis, in which partial rotation or torsion of the head occurs along the longitudinal axis. In anterocollis, the head and neck are held in forward flexion with increased tone of anterior cervical muscles; in retrocollis, the head and neck are held in hyperextension with increased tone in the posterior cervical muscles.
No matter which term is preferred in communicating about these conditions, the implication is that they all represent differing degrees of the same phenomenon. Jankovic et al
and Chan et al
preferred to avoid the popular term spasmodic torticollis and instead preferred cervical dystonia, because many patients have neither simple rotation nor spasmodic movements. In fact, several patients have combinations of movements, not as simple tremors but as responses to dystonic motor control.
Torticollis is not a diagnosis but a symptom of diverse conditions. Presentations of torticollis or cervical dystonia are often defined using causal terms—acute torticollis, congenital torticollis, chronic torticollis, or acquired torticollis, idiopathic or secondary. The last implies a chronic etiology, often of a structural nature (eg, odontoid fracture, cystic mass, cervical adenitis). Some of the more common causes include congenital problems, trauma, and infections.