Torticollis: Blocked neck, what to do? (practical advice)

cervico-brachial neuralgia due to work

Le torticollis is a frequent cause of cervicalgia, that is to say pain in the neck. It is usually due to a contraction or a spasm of one or more muscles of the cervical region. It can also be of skin, bone or joint origin.

Torticollis most often progresses to healing spontaneous. Sometimes, a drug treatment will be necessary in front of the persistence or the intensity of the symptoms.

Although benign et passenger in the vast majority of cases, torticollis can turn out to be very painful and severely handicapping. Fortunately, simple measures can relieve it effectively and prevent its recurrence.

What is torticollis?

Le torticollis, from the Latin “collum distorsum” meaning "twisted neck", is a deformity characterized by an involuntary and permanent tilting, congenital or acquired, of the head and neck.

The inclination of the head and neck can be done in various directions: backwards, forwards or laterally, hence the names: posterior, anterior or lateral torticollis, the torticollis lateral being the most common variety.

Le torticollis is a clinical manifestation common to many medical or surgical conditions. Its origin can be skin, bone or muscle:

  • Cutaneous: retraction of the skin and of the subcutaneous cellular tissue, for example following a burn or an abscess, can be complicated by so-called scarring torticollis.
  • Bone: in many cases torticollis is the consequence of a joint or bone (vertebral) injury. The latter is then either directly responsible for torticollis by causing a deformation of the cervical spine, or indirectly by causing painful reflex muscle contractures responsible for vicious attitudes of the head.
  • Muscular: the neck is made up of many muscles which play a vital role in the balance of the head thanks to their tone, and in its mobility by ensuring movements in the different planes of space. This balance can be broken by the occurrence of contractures, spasms, retractions or paralysis.

From a surgical point of view, the torticollis by muscular retraction, usually congenital, is the most common. However, the most common cause of this neck deformity, one that the vast majority of us will experience at some point in our lives, is the torticollis due to muscle spasm.

This results in the sudden appearance of pain more or less intense at the level of the neck and by a limitation of head movements in certain planes of space (depending on the muscle affected). We have the feeling that our neck is literally blocked!

This type of torticollis is usually benign and very quickly resolvable in a way spontaneous. The fact remains that it is highly handicapping.

What are the causes of torticollis?

There are many causes of torticollis. A distinction is mainly made between congenital torticollis and chronic torticollis:

Congenital torticollis

Le torticollis congenital is a deformity of the neck found at birth during the first clinical examinations of the baby. According to data from the literature, this condition affects boys more often than girls, usually affects the right side of the neck, is very frequently héréditaire et often associated with other birth defects such as cleft lip and palate (hare beak), clubfoot, LCH (congenital hip dislocation)…

In order to explain the genesis of congenital torticollis, multiple theories have been put forward by scientists. Here are the main ones:

  1. Incorrect position of the fetal neck intrauterine: for example due to oligohydramnios (reduction in the amount of amniotic fluid, which is the liquid in which the fetus bathes), malformations of the uterus, adhesions which hold the head of the fetus in a bad position against the wall of the uterus… Basically, the baby being cramped in the belly of the future mother, her whole body is under pressure and her neck twists.
  2. Muscle or nerve damage during intrauterine development: may be of inflammatory origin or secondary to anomalies of fetal development.
  3. Asymmetry of facial development during fetal life: one of the sides stops developing, which creates muscle tension in the neck.
  4. Traumatic lesions of the sternocleidomastoid muscle during childbirth: especially in case of difficult vaginal delivery, especially in breech presentations (theory disputed by many authors).

To learn more about congenital torticollis, see the following article.

Acquired torticollis

As mentioned above, torticollis can have several origins: skin, bone and joint, muscle, etc. We will detail in this part the causes of the torticollis muscular " common ".

Muscle torticollis is caused by a spasm ou contraction involuntary unilateral (usually) one or more of the muscles of the neck (the most affected being the trapezius and the sterno-cleido-mastoid).

This contraction muscular reflex settles under the influence of various causes:

  • Sleep in a bad position (especially the prone position).
  • Poor posture at work (especially office work).
  • Exposure to cold or cooling.
  • Sudden movement or trauma to the neck.
  • Physical overwork.
  • Intellectual overwork.
  • Reflex local irritation.
  • Lesion of one of the organs in the vicinity of a neck muscle (cervical adenitis, damage to the thyroid gland, dental damage, damage to the ear, furuncle, etc.).
  • Depression and stress.
  • Strong emotions (sorrow, fear, etc.).
  • Menopause.

Many other causes of muscular torticollis are possible such as infections (meningitis, typhoid fever, etc.), rheumatic diseases, inflammatory diseases, certain medications, certain tumours, etc. A opinion medical is always desired in order to make sense of things.

What are the symptoms of torticollis?

The two main symptoms of torticollis are pain at the level of the neck, or “neck pain”, and the movement blocking of the head. Depending on the variety of torticollis (posterior, anterior or lateral), the pain may sit behind, in front or on the side of the neck. As for the blockage, it boils down to an inability or difficulty in moving the head fluidly and painlessly.

In its typical form, torticollis is characterized by a lateral tilt of the neck with rotation of the head contralaterally.

For example: right lateral torticollis = pain on the right side, inclination of the neck to the right (on the same side) and rotation of the head to the left (contralateral, that is to say towards the side opposite the lesion). 

Other symptoms may occur:

  • Neck stiffness.
  • Elevation of one shoulder relative to the other (contracture of the trapezius muscle).
  • Headache.
  • Shoulder pain.
  • Pain in the arm (simple irradiation or secondary to inflammation of a nerve root linked to a herniated disc or an cervical spondylosis).
  • Dorsalgia (pain in the back).
  • Fever.
  • Joint pain elsewhere (location other than the neck).

How is torticollis diagnosed?

Diagnosis is easy when it comes to a torticollis typical. Indeed, the questioning of the doctor supplemented by a meticulous physical examination is enough to strongly evoke the diagnosis of torticollis.

The doctor's questioning will specify the characteristics of neck pain (the medical history, in particular those concerning the cervico-facial region, the mode and the circumstances of occurrence, evolution over time in an acute or chronic manner, the precise location of the pain and its possible irradiations, the associated symptoms, etc.).

In a second step, or in parallel with the interrogation, the physical examination will show pain on passive and active mobilization of the head, rigidity in the muscles of the neck and a limitation of movement.

When the doctor concludes that it is a typical acute and benign torticollis, no exam complementary will not be necessary.

In some cases, before the character atypical symptoms, additional examinations may be prescribed by the doctor. He may then request an X-ray, a computed tomography (scanner), an MRI, a biological assessment, etc. This is to highlight certain bone and muscle abnormalities or other lesions that may explain the symptomatology.

When to consult?

In typical cases, the occurrence of torticollis does not necessarily require a medical consultation. It's a love benign which, in the vast majority of cases, heals spontaneously in a few hours to a few days.

However, there are certain circumstances that require a consultation medical :

  • Persistence of neck pain (several days or weeks).
  • Radiating arm pain.
  • Burning sensation or tingling in the arm.
  • Frequent recurrences (the torticollis comes back several times a month or a year).
  • Symptoms indicating an infection (fever, aches, headaches, photophobia, etc.).
  • Baby or child torticollis.
  • Pain associated with signs of shock (pallor, sweating, coldness of the extremities, ringing in the ears, cyanosis, dizziness, anxiety, impaired consciousness, palpitations, etc.).

What is the treatment for torticollis?

Torticollis does not require treatment. He cures spontaneously in a few hours to a few days. Time is therefore the main treatment for this benign condition.

While waiting for spontaneous healing, there are certain therapeutic measures to put in place to relieve the pain:

  1. Medicine analgesic simple (paracetamol, nonsteroidal anti-inflammatory drugs such as ibuprofen or ketoprofen).
  2. Medicine muscle relaxant (which allows muscle relaxation and a reduction of painful tension).
  3. Applying heat (hot water bottles or heating patches).
  4. Temporary wearing of a necklace cervical in foam (neck brace) to support the head and limit painful movements. Seek advice from a healthcare professional first.
  5. Sessions massage, stretching sweet and / or therapeutic exercises with a professional such as a physiotherapist, a chiropractor or an osteopath. It is also possible to perform self-massages to relieve pain.

Attention, the total immobilization of the neck is not recommended during torticollis. It is necessary to keep a certain mobility, even minimal, so as not to delay healing.

In all cases, and particularly in certain circumstances (mentioned earlier in the article), it will be necessary to have a doctor's opinion or another healthcare professional so as not to miss a potentially severe pathology that could mimic the clinical picture of benign torticollis.

How to sleep with torticollis?

Sleeping with a torticollis is not an easy task! The pains being frequently very intense, it is very difficult to obtain a position which makes it possible to relieve them to finally rest.

Fortunately, there are some tricks:

  1. Before to sleep : Take an analgesic to relieve pain and help you fall asleep. It is also beneficial to perform self-massages of the cervical region using massage oil to reduce muscle tension and pain.
  2. Sleep on the side: lateral decubitus is a position suitable for sleeping, as it respects the natural alignment of the spine (respecting its physiological curvatures). You just need to place a pillow thick enough to fill the space between the head and the plane of the bed in order to keep the cervical spine well aligned with the rest of the spine. This is to ensure that all the muscles of the spine are relaxed, and therefore less pain.
  3. Sleep on your back: Supine position is also a very good position for sleeping. It ensures muscle relaxation of the whole body for optimal rest. For this position, a thin pillow at the level of the neck is enough to ensure a good alignment of the vertebrae.
  4. Avoid sleeping on your stomach: the prone position does not respect the physiological curvatures and the alignment of the spine. It therefore promotes deformations of the spine and the appearance of painful tensions, especially at the cervical level.

To benefit from a orthopedic pillow ideal shape memory in the presence of torticollis, see the following article.

How to prevent torticollis?

To prevent the installation of a torticollis or its recurrences, it is enough to adopt the good habits on a daily basis:

  • Maintain good posture at all times : standing, sitting, lying down, at work, at home, in front of the screen…
  • Have suitable bedding: orthopedic mattress, pillows adapted to the sleeping position (thick for the position on the side, thin for the position on the back).
  • Sleep in the right position: avoid sleeping on your stomach, especially in the presence of chronic neck stiffness. The alignment of the vertebral column is not optimized in these circumstances, which favors the appearance of pathologies of the cervico-dorsal spine and muscular tensions.
  • Cover yourself well: it is necessary to protect oneself from the cold (in particular by wearing a scarf or a scarf around the neck), because it represents one of the frequent causes of acute torticollis.
  • Practice regular physical activity: strengthening and gentle stretching of the neck muscles can prevent various musculoskeletal pathologies, including torticollis.
  • Reduce stress: stress is one of the contributing factors of torticollis.

References

[1] P. Peyrou and D. Moulies, “Child torticollis: diagnostic approach”, Arch. Pediatrics, flight. 14, no 10, p. 1264-1270, 2007.

[2] N. Lutz and PY Zambelli, “Torticollis”, Vade-Mecum Pediatrics, p. 344-347, 2014.

[3] P. Redard, “ Torticollis and its treatment ». Carré and Naud, 1898.

[4] P. Pitron, “Torticollis”, Cah. Bioth, p. 41-44, 2002.

[5] M. François, “What to do in front of a torticollis? », Arch Pediatrician, flight. 20, p. 22‑3, 2013.

[6] P. Wicart, “Congenital torticollis”, Arch. Pediatrics, flight. 19, no 3, p. 335-339, 2012.

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