Several neurological conditions can lead to chronic pain. While pain associated with some of these conditions can be treated with oral or injectable medications, others may need surgery to correct the condition. Torticollis, which is also known as wryneck, is a condition that affects people of all ages, including newborns.
What is Wryneck?
Wryneck, which is also known as spasmodic torticollis, is a condition that causes the muscles in the neck to twist and the head to tilt down toward a shoulder. It can be a painful condition due to the twisted muscles, but it can also cause muscle spasms.
The term torticollis gets its name from the Latin words tortus, meaning twisted, and Collum, meaning neck.
Causes of Wryneck
There isn’t always a specific cause for wryneck, but in adults, it can develop due to injuries to the spine or neck. The injuries can lead to muscle spasms and twisting of the head, which are the typical symptoms associated with wryneck.
Infections in the head or neck can lead to wryneck as well. Since the neck muscles lay over the lymph nodes in the neck, these muscles can spasm if the glands and lymph nodes are infected. Several disease or conditions can cause glands and lymph nodes to swell, including:
- Respiratory infections
- Rheumatoid Arthritis
- Dental injections
- Ear infections
Abscesses in the throat and upper airway can accompany wryneck and be life-threatening.
Injuries such as whiplash or falls can lead to a structural misalignment of the cervical vertebrae. When the vertebrae of the craniocervical junction (CCJ) shift, they can cause dysfunction of the spinal accessory nerve that innervates several muscles in the neck that are responsible for wryneck. Special imaging of the CCJ can identify whether this is the likely culprit.
Both illicit and pharmaceutical drugs have connections to the neck condition. People who abuse drugs like cocaine, ketamine, or amphetamines can lead to acute dystonia. Prescribed neuroleptic drugs like haloperidol, prochlorperazine, and chlorpromazine can also cause it.
Neuroleptic, or antipsychotic, drugs are not uncommon because they help manage conditions like:
- Bipolar Disease
- Psychotic Depression
- Senile psychoses
- Drug-induced psychoses
- Organic psychoses
Acute dystonia, which can lead to wryneck, is a sudden onset of contractions, or spasms, involving the muscles of the neck, face, or back.
In some rare cases these problems can lead to wryneck:
- Scar tissue
- Vascular problems
- Arthritis in the cervical spine.
In addition to the head tilting to one side, wryneck can also involuntarily cause upward movements of the eyes, called an oculogyric crisis, and a protruding tongue.
This condition can also cause:
- Shoulder and back pain.
- Muscle cramps in the neck.
- Burning sensations
Children with Wryneck
Some children with this condition can develop it because of injuries or infections. However, children may also be born with the condition, which is called congenital torticollis. If they are, it will show up within a few weeks after they are born.
The congenital form of the condition is usually caused by the tightness of one of the longest muscle in the neck, the sternocleidomastoid (SCM) muscle. It runs from the breastbone to the collarbone to the skull.
The muscle tightness may be due to the way the baby was positioned in the uterus, with the head tilted to the side. Other causes include damage to neck muscles during the baby’s birth and a structural shift of the cervical vertebra that results in a neuromuscular contraction of the SCM. 1 in about 250 babies are born with this condition, and 10% to 20% of them also have hip dysplasia.
A less common cause for congenital wryneck is abnormalities with the bones in the neck or cervical vertebrae. This condition, called Klippel-Fell Syndrome, may be due to the vertebrae not forming correctly, being fused together, or combination of the two causes. It can be hereditary as well.
Symptoms of Congenital Wryneck
The appearance of this condition usually takes place when babies are about two months old. Along with the characteristic head tilt, they may also have a bump on their neck.
A torticollis baby may develop an uneven head shape known as positional plagiocephaly since they usually sleep with their head turned to one side. To confirm a diagnosis of torticollis, their pediatrician may order x-rays of neck, hips, or kidneys.
If a child develops wryneck, then it is acquired, not congenital wryneck. Acquired wryneck may be due to muscle damage, infections, or inadequate blood circulation.
When to Seek Treatment
Most of the time, acute wryneck is not life-threatening, but you should go to an emergency room if you’ve had a neck injury and the muscles are spasming. Other medical conditions can cause the same symptoms as wryneck, but they can be more serious.
If you have these symptoms, it could mean there is an injury to your central nervous system, and you need to see a doctor immediately:
- Breathing or swallowing problems.
- Numbness, weakness, or tingling in the arms or legs.
- Bladder or bowel incontinence.
- Trouble urinating.
- Slurred speech.
- Trouble walking.
Seek immediate treatment if neck spasms are also accompanied by:
- Swollen glands
- Neck stiffness
- Swelling of the tongue or mouth.
- Trouble swallowing.
There are a variety of treatments doctors may prescribe for wryneck. They may prescribe oral or injectable medications, physical therapy, or surgery, especially if there are persistent neck muscle spasms.
Treatments for Babies
Babies with wryneck may be referred to a neurosurgeon or physical therapist for treatment. If they have the congenital form, then there are simple stretching and positioning exercises you will be shown for your baby. These exercises should be done several times a day.
With muscular wryneck, give your child as many opportunities as possible to turn his or her head to the side with which they have a problem. If your baby doesn’t turn his head to the left, then you can sit or lay him, so you’re to his left. Then when you address him, he will be forced to turn his head that way to see you.
An assessment by a chiropractor will identify whether the muscle contraction is secondary to a structural shift in the neck. If not, then physical therapy is best. However, a structural problem cannot be corrected by stretching the muscles. Gentle adjustments to the neck can alleviate the neuromuscular incoordination and balance the muscle symmetry.
Lay him on his stomach as much as possible to provide opportunities for him to strengthen his back and neck muscles. With persistence, you should see results of the exercises by the time they are a year old if it was diagnosed by the time they were two to three months old.
If there aren’t improvements by the time the baby is 18 months old, then you may need to see a surgeon. Surgery is only necessary in about 15% of wryneck cases.
To help treat spasmodic wryneck, doctors often prescribe oral medications like muscle relaxers and anti-inflammatory drugs. These drugs can usually relieve the muscle spasms with a few days.
For acute spasmodic wryneck, doctors will usually treat it by injecting benztropine and diphenhydramine into the muscles or a vein. They will also be prescribed orally to prevent the symptoms from reoccurring. A muscle relaxer or benzodiazepines may also be included in the injection.
If the neck spasms are chronic, then a doctor may inject botulinum A toxin, aka Botox, into the muscles. Botox can help prevent spasms, and it may lead to recovery since it can also stop the progression of wryneck.
Stretching and neck exercises can help strengthen muscles affected by spasmodic wryneck. Developing strong muscles will not only help to hold the head in the correct position, but it can also reduce pain the condition can cause.
Yoga and Pilates are gentle exercises that can lengthen and strengthen muscles in the neck and back. Whether the condition was caused by injuries or an imbalance in the strength of the neck and shoulder muscles, these exercises should be a priority for sufferers.
A simple way to strengthen the neck muscles is to do neck flexion and extensions with a hand acting as resistance during the exercises. You can also strengthen the back and shoulder muscles by doing shoulder shrugs while holding dumb bells or hand weights.
Along with strengthening the neck, you should do exercises to strengthen muscles in your entire body. Strong muscles help support the spine, maintain proper posture, and they can reduce muscle spasms.
Exercises like swimming, walking, and Tai Chi do not jar the neck or the body, which could trigger muscle spasms. Also, leg presses, chest presses, and rowing helps to strengthen core muscles, which are essential for having good posture.
Along with working out, you could also do passive stretching, which is allowing a physical therapist to move your body with their hands. This type of movement is also called physiotherapy.
When you start receiving treatments, a physical therapist may start with passive exercises and then have you progress to active exercises after they show you how to do them.
Surgery is the option of last resort and is rarely performed to treat wryneck. However, if you have severe neck torticollis and require surgery, some of the nerves and/or muscles in the neck may be severed to prevent muscle spasms. However, surgery is only a short-term solution as the neck often becomes twisted again after a few months.
An even more rare procedure is to perform deep brain stimulation by inserting a wire into the area of the brain responsible for movement and transmitting electrical signals to disrupt the brain’s signals that cause torticollis.
Most people with this condition live fulfilling lives and do exercises or take medications to control any spasms or pain they experience.