Torticollis

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Torticolis , also known as neck neck , is a dystonic condition determined by abnormal asymmetric head or neck position, which may be caused by various causes. The term torticollis is derived from Latin tortus to play and collum for the neck.

The most common cases do not have a clear cause, and the pain and difficulty with turning the head usually disappears after a few days, even without treatment.

Video Torticollis

Signs and symptoms

Torticolis is a fixed or dynamic tilt, rotation, or arch with flexion or head and/or neck extension. The type of torticollis can be depicted depending on the position of head and neck.

• laterocollis : head towards shoulder
• torticollist rotation : head rotates along the longitudal axis
• anterocollis Ã,: head and neck flexion
• retrocollis Ã,: hiperekstensi head and neck backward

The combination of these movements can often be observed. Torticollis can be a disorder and symptoms in other conditions.

Other symptoms include:

• Neck pain
• The occasional formation of a mass
• The sternocleidomastoid muscle is thickened
• Softness on the spine of the neck
• Tremor in the head
• The shoulder height is not equal
• Movement of the neck decreases

Maps Torticollis

Cause

Various conditions can lead to torticol- ogy developments including: muscle fibrosis, congenital spinal disorders, or traumatic or traumatic brain injury. Rough categorization distinguishes between congenital torticolism and acquired torticolism.

Other categories include:

• Osseous
• Traumatic
• CNS/PNS
• Okular
• Non-muscular soft tissue
• Spasmodic
• Induced drugs

Congenital torticolid muscle

The innate muscle torticollis is the most common torticollist present at birth. The congenital causes of cortical torticosis are unclear. Birth trauma or intrauterine malposition is considered a cause of sternokleidomastoid muscle damage in the neck. Other changes in muscle tissue arise from recurrent microtrauma in the uterus or a sudden change in calcium concentration in the body that causes prolonged periods of muscle contraction.

One of these mechanisms can produce shortened or excessive contraction of the sternocleidomastoid muscle, which limits the range of motion in both rotation and lateral flexure. The head usually tilts toward the lateral bent towards the affected muscle and is rotated toward the opposite side. In other words, in the direction toward the shortened muscles with the chin tilted in the opposite direction.

Congenital Torticollis is presented at 1-4 weeks of age and a hard mass usually develops. Usually diagnosed using ultrasound and color histogram or clinically through an evaluation of the passive range of cervical motion of the baby.

Sinusital torticollis is the majority of cases seen in clinical practice. The reported incidence of congenital torticolysis is 0.3-2.0%. Sometimes the mass, such as a sternocleidomastoid tumor, is noted in the affected muscle at the age of two to four weeks. Gradually disappear, usually at the age of eight months, but the muscles are left fibrotic.

Acquired torticollis

Noncongenital muscle tachycolis may occur due to scarring or cervical vertebral disease, adenitis, tonsillitis, rheumatism, enlarged cervical glands, retrofaring abscesses, or cerebellar tumors. It may be spasmodic (clonic) or permanent (tonic). The latter type may be caused by Potted Disease (spinal tuberculosis).

• A spontaneous form of spontaneous torticosis with one or more painful neck muscles is the most common ("stiff neck") and will pass spontaneously within 1-4 weeks. Usually the sternocleidomastoid muscle or trapezius muscle is involved. Sometimes drafts, colds, or unusual postures are implied; But in many cases there is no obvious cause. This episode is usually seen by doctors.
• The skull base tumor (posterior fossa tumor) can suppress the nerve supply to the neck and cause torticollis, and this problem should be treated surgically.
• Posterior pharyngeal infections may irritate the nerves that supply the neck muscles and cause torticollis, and these infections can be treated with antibiotics if not too severe, but may require debridement in difficult cases.
• Ear infection and surgical removal of the thyroid can cause an entity known as Grisel syndrome, subluxation of the upper cervical joint, mostly atlantoaxial joint, due to inflammatory ligament inflammation caused by infection.
• The use of certain drugs, such as antipsychotics, can cause torticollis.
• Antiemetics - Class Neuroleptics - Phenothiazines
• There are many other rare causes of torticolism. A very rare cause of torticollis is fibrodysplasia ossificans progressiva (FOP), characteristic of a misformed toe.

spasmodic Tortikolis

Torticollis with recurrent contractions, but while the muscles of the neck and especially sternocleidomastoid, called spasmodic torticollis. Synonyms are "intermittent torticollis", "cervical dystonia" or "idiopathic cervical dystonia", depending on the cause.

Trochlear torticollis

Torticollis may not be associated with sternocleidomastoid muscle, not caused by damage to the trochlear nerve (the fourth cranial nerve), which supplies the superior oblique muscle of the eye. Superior oblique muscles engage in depression, abduction, and introsio eyes. When the troklear nerve is damaged, the eyes are squeezed because the superior oblique does not work. The affected person will have vision problems unless they turn their heads away from the affected side, causing eye introspection and balancing out the eyes. It can be diagnosed with a Bielschowsky test, also called a head-tilt test, in which the head is directed to the affected side. A positive test occurs when the affected eye rises, appearing to float.

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Anatomy

The underlying anatomical distortion causing torticollis is a shortened sternocleidomastoid muscle. It is a neck muscle originating from the sternum and clavicle and inserts on the mastoid process of the temporal bone on the same side. There are two sternocleidomastoid muscles in the human body and when both are contracted, the neck is flexed. The main blood supply for these muscles comes from the occipital arteries, superior thyroid arteries, transverse scapular arteries and transversal cervical arteries. The main innervation for these muscles is from the cranial nerve XI (accessory nerve) but the second, third and fourth cervical nerves are also involved. Pathology in this blood and nerve supply can lead to torticollis.

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Diagnosis

Evaluation of children with torticollis begins with anamnesis to determine the circumstances surrounding the birth and the possibility of trauma or related symptoms. Physical examination shows decreased rotation and bends to the opposite side of the affected muscle. Some say that innate cases more often involve the right side, but there is no complete agreement on this in published research. The evaluation should include a thorough neurologic examination, and possibly related conditions such as hip and crown hip dysplasia should be examined. Radiographic cervical spine should be obtained to rule out clear bone abnormalities, and MRI should be considered if there are concerns about structural problems or other conditions.

Ultrasonography is another diagnostic tool that has high frequency sound waves used to visualize muscle tissue. Color histograms can also be used to determine the cross-sectional area and the thickness of the muscles.

Evaluation by an ophthalmologist or ophthalmologist should be considered in children to ensure that the torticollis is not caused by vision problems (IV cranial nerve palsy, nystagmus-related "zero position," etc.).

Diagnosis banding untuk tortikolis

• Palsi saraf IV palsy
• Spasmus nutans
• Sindrom Sandifer
• Myasthenia gravis

Cervical dystonia that appears in adulthood has been believed to be idiopathic, since special imaging techniques most often find no specific cause.

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Treatment

Initially, this condition is treated with physical therapy, such as stretching to release tightness, strengthening exercises to improve muscle balance, and handling to stimulate symmetry. A TOT collar is sometimes applied. Initial initiation of treatment is essential for full recovery and to reduce the chances of relapse.

Physical therapy

Physical therapy is an option to treat torticollis in a non-invasive and cost-effective way. While an outpatient physiotherapy is effective, home therapy performed by a parent or guardian is equally effective in reversing the effects of congenital torticollis. Lateral neck flexion and overall range of motion can return faster in newborns when parents do physical therapy exercises several times a day.

The physical therapist should teach parents and guardians to do the following exercise:

• Stretches the muscles in the prone position both actively and passively
• Stretch the muscles in the lateral position supported by the pillow (the baby lying on his side with the neck supported by the pillow). The affected side should fight the pillow to stray the neck towards the unaffected side.
• Posture should be controlled in strollers, car seats and swings (using U-shaped neck pillows or blankets to hold the neck in a neutral position)
• Exercise active rotation in the supine, sitting or stomach position (use toys, lights and sounds to draw the baby's attention to rotate the neck and look toward the unaffected side)
• Passive cervical rotation (like stretching when supported by pillow, has affected bottom side)
• Position baby in cradle with side hit by wall so they have to switch to unexposed side to face out

Physical therapists often encourage parents and caregivers of children with torticollis to modify the environment to improve movement and neck position. Modifications may include:

• Add a neck brace to the car seat to achieve optimal neck alignment
• Reduce time spent in one position
• Use toys to encourage children to look toward restricted neck motions

Micro therapy

A recent Korean study introduces additional treatments called micro therapies that may be effective in treating congenital torticollis. For this therapy to be effective, children should be under three months old and have a torticollis involving all sternocleidomastoid muscles with a palpable mass and a thickness of muscle above 10 mm. Microwave therapy sends minute electrical signals to the network to restore normal frequency in the cell. Micro therapy is completely painless and children can only feel the probe from the machine on their skin.

Micro therapies are thought to increase ATP and protein synthesis and improve blood flow, reduce muscle spasms and reduce pain and inflammation. These should be used in addition to regular stretching exercises and diathermy ultrasonography. Ultrasound diathermy produces deep heat inside the body tissues to help contractures, muscle aches and pains and reduce inflammation. This combination of treatments showed remarkable results in the duration of time children were maintained in the rehabilitation program: Micocurrent therapy can cut the length of the rehabilitation program by nearly half with full recovery seen after 2.6 months.

About 5-10% of cases fail to respond to stretching and require surgery of the muscles.

Surgery

The release of surgery involves two free sternokleidomastoid muscle heads. This surgery can be done minimally invasive and done laparoscopically. Usually surgery performed on those older than 12 months. Surgery is for those who do not respond to physical therapy or botulinum toxin injection or have a very fibrotic sternocleidomastoid muscle. After surgery, the child will be asked to wear a soft neck collar (also called a Callot cast). There will be an intensive physiotherapy program for 3-4 months as well as strengthening exercises for the neck muscles.

Other treatments include:

• Rest and analgesics for acute cases
• Diazepam or other muscle relaxants
• Botulinum toxin
• Encourage active movement for children 6-8 months
• Ultrasound diathermy

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Prognosis

Studies and evidence from clinical practice show that 85-90% of congenital torticolysis cases are resolved with conservative treatment. It is possible that the torticollist will heal spontaneously but the possibility of a recurrence may occur.

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Other animals

In veterinary literature it is usually only the lateral bend of the head and neck called torticollis, whereas the analogon in torticollis turns on the human is called the slope of the head. The most common form of torticollis found in domestic pets is the inclination of the head, but sometimes there is a lateral curve of the head and neck on one side.

Head tilt

The cause of head tilt in domestic animals is a disease of the central or peripheral vestibular system or loss of posture due to neck pain. Known causes for head tilt in domestic animals include:

• Encephalitozoon cuniculi (or E. cuniculi ) infection in rabbits
• Inner ear infections
• Hypothyroidism in dogs
• Cranial nerve disease VIII N. Vestibulocochlearis through trauma, infection, inflammation or neoplasia
• Brain disease originates from stroke, trauma or neoplasia
• Damage to vestibular organs due to toxicity, inflammation or impaired blood supply
• Geriatric vestibular syndrome in dogs

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Note

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References

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External links

• Head Tilt: Cause and Treatment

Source of the article : Wikipedia