Torticollis

Excerpt

Torticollis or twisted neck (tortum collum) of Italian origin "torti colli" is a vicious attitude of the head and neck, typically presenting with abnormal slope and rotation. There may be several presenting positions, including flexion, extension, right or left tilt. These have names such as horizontal torticollis, vertical, oblique, or torsion.

Torticollis is a common diagnosis, and estimates are that 90% of people will exhibit at least one episode of torticollis throughout their lives.

Torticollis may be benign (congenital torticollis) but may also be due to serious causes such as brain injury.

The most frequent and common cases seem to be related to dysfunctions in the local neuromuscular mechanisms (focal dystonia). Cervical dystonia is among the most common focal dystonias in adults, causing a tetanus contraction of the sternocleidomastoid and/or trapezius muscles.

Depending on the affected muscles, the shape of the neck will be different. It is worth noting that other changes in the position of the head and neck are not necessarily torticollis.

Cervical Muscular Anatomy:

The muscles of the neck form a complex system. Schematically, two levels are distinguished: superficial (long neck muscles) and deep (paravertebral muscles).

The primary muscles involved in cervical dystonia are:

The sternocleidomastoid is the most targeted muscle. It is in the anterior region of the neck, where it forms a visible and palpable mass. Its insertions on the sternum (sternum furcula), clavicle (medial aspect), occipital region (lateral neckline), and mastoid. The muscle fibers have an obliquely upward and outward direction. The action of the sternocleidomastoid is to perform contralateral rotation, ipsilateral inclination, and flexion of the head.

Other muscles of the region involved in torticollis include the splenius, the trapezius, the scapula, the scalenes, and the platysma.

There are eight sets of cervical nerves, outlined C1 to C8, and each pair leaves the spinal cord at the corresponding vertebral level. These nerves are particularly susceptible to nerve compression associated with pathological changes.