Internal Medicine

0521779407-20 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:22

Torticollis 1435

TOR TICOLLIS

CHAD CHRISTINE, MD

history & physical

■Involuntary turning of head & neck

■Typical onset in 3rd or 4th decade; may occur at any age

■May be family history

■Sensory trick (touching chin, occiput, etc.) often temporarily relieves

deviation

■Pain is common

■Involuntary contraction of selective neck muscles causing head devi-

ation

■Simultaneous activation of agonist & antagonist muscles

■Shoulder may be elevated

■Movement may be slow or jerky

■Spasms worse w/ activity

tests

■Diagnosis made clinically

■Laboratory: genetic tests available for hereditary forms; rule out

Wilson’s disease

■Imaging: indicated if torticollis follows head or neck injury or if other

neurologic features are present

■EMG may show sustained or intermittent activity of cervical muscles

differential diagnosis

■Structural lesion, Wilson’s disease

management

■General measures

➣Treat pain w/ NSAIDs

➣Physical therapy & prosthetic devices that take advantage of sen-

sory trick may be helpful

specific therapy

■Indications: symptoms that interfere w/ function

■Botulinum toxin local injection

➣Injected into abnormally contracting muscles

➣Must be repeated every 3–5 months in most pts

■Oral meds

➣Anticholinergics: benztropine or trihexyphenidyl

➣GABA agonists: baclofen, clonazepam, diazepam