Torticollis

With torticollis ( Latin for " torticollis ", "turned" by tortus, " curved " and collum "neck" ) refers to a congenital or acquired imbalance or abnormal posture of the neck. The reasons for this are varied and can, for example, expression of a neurological disorder be (cervical dystonia), when it comes to uncontrolled movements ( torticollis or spasmodic Spasticus ) or malposition of the head. For painful diseases of the ear, nose and throat medicine symptomatic torticollis may occur as a protective posture. In ophthalmology we know a " ocular torticollis " as a compensatory mechanism during an eye muscle paralysis and nystagmus. Also rheumatic forms are known.

Molding

In medicine, different types can be distinguished, which can also occur in combination:

• Rotation: Rotary torticollis
• The inclined shoulder: laterocollis
• Bent forward on the chest: Anterocollis
• Back hyperextended: Retro Collis

The bad posture may be accompanied by rhythmic and sometimes violent movements. Not infrequently, the axis between the head and body is shifted and it can also come at a high shoulder stand.

Causes

A distinction is made between hereditary muscular, skeletal -related (eg, Klippel -Feil syndrome), rheumatoid, ocular, somatoform, and neurological causes. In the latter, the disease process in the brain plays in the extrapyramidal system and here specifically in the basal ganglia. Known causes for this may be:

• Damage to certain regions of the brain caused by strokes, tumors, brain injury or inflammation, vascular malformations, the consequences of accidents ( whiplash )
• Metabolic diseases
• Taking medications that act on the basal ganglia
• Birth trauma due to hemorrhage into the sternocleidomastoid
• Tumor of the posterior fossa
• Calcification of intervertebral discs
• Injury ( torticollis traumaticus )
• As pain-related posture for inflammation of the ear, nose and throat area ( Grisel 's syndrome), such as in peritonsillar abscess, acute cervical lymph node inflammation, Bezold 's abscess

Usually no damage is noted (idiopathic disease).

Congenital muscular torticollis

The clinical picture of congenital ( inborn ) torticollis, also known as " congenital torticollis muscularis ", is caused by a shortening of the sternocleidomastoid muscle. This form of torticollis must be treated kinderorthopädisch always early.

Ocular torticollis

The symptom of a head tilt is also available in ophthalmology ( ocular torticollis or head posture ) to compensate for an eye muscle imbalance. They may take the form of head rotation, tilt, survey or downward revision or a combination of all of these forms may occur.

The most common cause of ocular head posture is the paralysis of one or more eye muscles. This results in restrictions on the movement ability of the eye and squinting with the appearance of double images. To avoid this double vision, turns the patient usually head toward the affected muscle to leave his action area. The view is directed in a direction in which the muscle is minimal or non- active and therefore occur in the ideal case, no double images. It also happens that people take with an eye muscle imbalance a head posture in order to increase the distance of the double images of one another, so much so that its occurrence is no longer disruptive. In this case, the head is directed opposite to the direction of tension and restricted movement of the affected muscle.

Another reason for taking a head posture is a so-called nystagmus ( nystagmus ). This can be achieved in some cases by the head position relative or even absolute calm of the eye tremor and thus an improvement of visual acuity.

The exact analysis and measurement of all components of a head posture is an important diagnostic aspect in terms of a therapeutic approach in the field of Strabismus and Neuro-ophthalmology.

Treatment

A universally established therapy existed not because of the different genesis. Not infrequently, rehabilitation measures are necessary. Treatments for cervical dystonia may be:

• Injection of botulinum toxin into the affected muscles
• Physiotherapy, possibly even before the age of 1 year
• Taking medication ( eg biperiden in acute cases )
• Surgical procedures, such as denervation (surgical separation of the nerve from the affected muscle) or myotomy (surgical transection of muscles)
• In case of ocular torticollis due the treatment of the underlying disease is, for example, by eye muscle surgery in the foreground.

Course

Depending on the cause in addition to a spontaneous healing often periods of improvement and deterioration may occur in the course of a day.

Even after surgical treatment, a further physiotherapy treatment and regular follow-up should be performed in order to notice a recurrence time. If left untreated, certain forms of torticollis can lead to long-term consequences.

Veterinary medicine

Forming torticollis are also known in the field of veterinary medicine, for example in the rabbit.