Torticollis is an abnormal twisted or tilted position of the head and neck. In infants it usually comes from a tight sternocleidomastoid muscle, while in older children and adults it can follow muscle spasm, infection, medicines or cervical dystonia.
Key symptoms
- Head tilted to one side with the chin turned to the other
- Neck pain and stiffness, often on waking
- Limited turning of the head
- Infant prefers looking one way and may have a flat spot on the head
- Pulling or shaking of the head that comes and goes (dystonia)
What you find on exam
- Head position and range of motion in all directions
- Firm lump or tight band in the sternocleidomastoid in infants
- Fever, swollen neck nodes or sore throat
- Neurologic exam: strength, reflexes, eye movements
- Hip exam in infants for developmental dysplasia
Tests
- Usually none for a typical muscle spasm
- Cervical spine X-ray after trauma or with neurologic signs
- Neck ultrasound in infants if a mass is felt
- CT or MRI if infection, abscess or tumor is suspected
Treatment basics
- Infant: stretching, tummy time and positioning, with physical therapy
- Acute adult spasm: heat, gentle movement, NSAIDs such as ibuprofen, short course of a muscle relaxant
- Drug-induced dystonia: diphenhydramine or benztropine
- Cervical dystonia: botulinum toxin injections
- Treat the cause, such as an infection or abscess
Red flags
- Fever with drooling, trouble swallowing or noisy breathing
- Neck injury, numbness or limb weakness
- Torticollis with headache, vomiting or abnormal eye movements
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.