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Torticollis

Torticollis, commonly known as wry neck, is a medical condition characterized by the involuntary contraction or shortening of the neck muscles, resulting in an abnormal tilt, turn, or rotation of the head to one side.^[1] The term originates from Latin words meaning "twisted neck," reflecting the visible distortion of head position due to affected muscles, most often the sternocleidomastoid.^[2] This condition can manifest as a congenital issue present at birth or as an acquired disorder developing later in life, with symptoms ranging from mild discomfort to significant limitation in neck mobility.^[3] Congenital muscular torticollis (CMT), the most prevalent form in infants, typically arises from fibrosis or hematoma in the sternocleidomastoid muscle during fetal development or birth, leading to unilateral shortening that pulls the head toward the affected side while rotating the chin away.^[4] Acquired torticollis, by contrast, encompasses acute episodes triggered by trauma, infection, or muscle strain, as well as chronic forms like cervical dystonia (spasmodic torticollis), a neurological disorder involving involuntary, sustained contractions of neck muscles.^[5] Other causes include ocular issues, tumors, or inflammatory conditions, though these are less common.^[6] Common symptoms include persistent head tilt (laterocollis), rotation (rotational torticollis), or forward flexion (anterior torticollis), often accompanied by neck stiffness, pain, headaches, and restricted range of motion.^[7] In congenital cases, it may also lead to facial asymmetry or plagiocephaly if untreated, while adult-onset forms can cause significant functional impairment and emotional distress.^[8] Diagnosis generally relies on clinical history and physical examination, supplemented by imaging such as ultrasound for infants or MRI for adults to exclude underlying structural or neurological pathologies.^[3] Treatment approaches vary by type and severity but emphasize conservative measures first. For congenital torticollis, early physical therapy focusing on stretching, positioning, and strengthening exercises is highly effective, often resolving the condition in 90% of cases within the first year.^[9] Acquired acute torticollis may respond to rest, heat, anti-inflammatory medications, or muscle relaxants, while chronic spasmodic torticollis is managed with botulinum toxin injections to weaken overactive muscles, oral medications like anticholinergics, or deep brain stimulation in refractory cases.^[5] Surgical intervention, such as tenotomy of the sternocleidomastoid, is reserved for persistent or severe instances unresponsive to other therapies.^[4]

Definition and Classification

Definition

Torticollis is a medical condition characterized by the involuntary contraction or shortening of the neck muscles, resulting in an abnormal positioning of the head relative to the body. This abnormal posture typically manifests as a lateral tilt of the head (laterocollis), rotational deviation (torticollis), or forward flexion (anterocollis), and is commonly known as "wry neck."^[3]^[7]^[1] The term "torticollis" originates from Latin roots, combining "tortus" meaning twisted and "collum" meaning neck, reflecting the characteristic deformity. It was first documented in medical literature in the early 19th century, around 1811, as a description of wryneck affecting the head and neck muscles.^[10]^[11] In congenital muscular torticollis, it presents with a characteristic triad of features: ipsilateral head tilt toward the affected side, contralateral rotation of the chin, and restricted range of motion in the neck. These signs arise from the imbalance in neck muscle tone, leading to the fixed abnormal posture.^[12]^[13]^[14] Torticollis is broadly classified into congenital, acquired, and spasmodic types, each with distinct etiologies and presentations.^[3]

Types

Torticollis is broadly classified into congenital and acquired forms based on the timing of onset, with further subdivisions reflecting differences in underlying mechanisms and clinical presentation. Congenital torticollis manifests at or shortly after birth, while acquired torticollis develops later in life, often due to identifiable triggers such as injury or disease. These distinctions aid in directing diagnostic and therapeutic approaches, emphasizing the need to differentiate muscular from neuromuscular or structural origins.^[3] Congenital muscular torticollis (CMT) is the most common form, present at birth and primarily resulting from fibrosis or shortening of the sternocleidomastoid (SCM) muscle, leading to ipsilateral head tilt and contralateral rotation. It affects approximately 1 in 250 infants, with a higher incidence in males and right-sided involvement. This type typically arises from intrauterine positioning, birth trauma, or vascular compromise to the SCM during delivery, though the exact pathogenesis remains multifactorial.^[4]^[4] Acquired torticollis emerges postnatally and encompasses a diverse group of conditions triggered by trauma, infections, neurological disorders, or medications, with onset varying from infancy to adulthood. It is subdivided into secondary forms, such as those induced by neuroleptic drugs (e.g., acute dystonic reactions) or underlying pathologies like tumors, and idiopathic variants without a clear precipitant. Presentation often involves acute or progressive neck deviation, distinguishing it from the more static congenital patterns, and requires evaluation for reversible causes.^[15]^[16] Spasmodic torticollis, also known as cervical dystonia, is an adult-onset focal dystonia characterized by involuntary, sustained muscle contractions in the neck, resulting in abnormal head postures. It typically begins between ages 30 and 50, with spasms classified as simple (involving rotation in one plane, such as laterocollis or anterocollis) or complex (multidirectional, combining rotation, tilt, and extension). The condition is idiopathic in most cases, though genetic factors may contribute, and it leads to intermittent or persistent torticollis without fixed deformity.^[5]^[17] Ocular torticollis represents a rare compensatory subtype arising from ocular misalignment, most commonly superior oblique palsy (previously termed trochlear nerve palsy), where head tilting restores binocular vision and minimizes diplopia. It is observed in approximately 3% of pediatric ophthalmology cases and presents with a characteristic ipsilateral tilt, often evident in early childhood as visual demands increase. Unlike muscular forms, resolution may follow correction of the underlying ocular issue.^[18] Other rare types include atlantoaxial rotatory subluxation, a structural misalignment at the C1-C2 junction often following minor trauma in children, presenting as acute, painless torticollis with limited neck motion, and Sandifer syndrome, a paroxysmal dystonic disorder in infants linked to gastroesophageal reflux, featuring episodic head tilting and back arching that spares the limbs. These variants highlight the spectrum of non-muscular etiologies and necessitate specialized imaging or gastroenterological assessment for diagnosis.^[19]^[20]

Epidemiology

Prevalence

Torticollis manifests in both congenital and acquired forms, with distinct prevalence patterns. Congenital muscular torticollis (CMT), the most common type in infants, affects approximately 0.3% to 2% of newborns worldwide.^[4] Spasmodic torticollis, a focal dystonia representing an acquired form, has an annual incidence of 9 to 28 cases per million adults.^[21] Age distribution highlights the bimodal nature of the condition. CMT typically peaks in infancy, with symptoms often emerging around 3 to 4 weeks post-birth as head tilting becomes apparent.^[4] In contrast, acquired forms like spasmodic torticollis predominantly occur in adults aged 30 to 50 years.^[17] Demographic trends reveal gender disparities, particularly in congenital cases. CMT shows a slight male predominance, with a male-to-female ratio of 3:2.^[4] Globally, prevalence varies by region; rates are lower in some Asian populations (around 0.3%) compared to European studies reporting up to 16%, potentially influenced by differences in screening and reporting.^[22] As of 2025, recent reviews confirm stable overall incidence for congenital forms but note enhancements in early detection through ultrasound assessments of associated musculoskeletal issues.^[23]

Risk Factors

Risk factors for torticollis encompass both non-modifiable and potentially modifiable elements that elevate susceptibility, particularly distinguishing congenital muscular torticollis (CMT) from acquired forms like spasmodic torticollis. Prenatal conditions such as breech presentation, oligohydramnios, and intrauterine constraint are associated with a substantially higher incidence of CMT, with breech deliveries linked to rates up to 1.8% compared to 0.3% in uncomplicated vertex presentations.^[24]^[12] Difficult deliveries, including those involving limited fetal space in first pregnancies, further contribute to this risk by promoting abnormal neck positioning.^[25] Perinatal trauma represents a key modifiable risk, often resulting in sternocleidomastoid muscle injury during birth. Forceps or vacuum extraction can cause direct trauma to the muscle, leading to fibrosis and subsequent torticollis in affected infants.^[4]^[26] This mechanism underscores the importance of careful delivery techniques to mitigate such injuries.^[27] Genetic factors play a prominent role in familial cases of spasmodic torticollis, a form of cervical dystonia, with approximately 10-25% exhibiting hereditary patterns. Mutations in the DYT1 (TOR1A) gene are implicated in some familial instances, contributing to dystonic features including neck involvement, though penetrance is reduced at 30-40%.^[28]^[29] For acquired torticollis, environmental triggers include exposure to neuroleptic drugs such as antipsychotics, which can induce acute or tardive dystonic reactions manifesting as neck spasms.^[30] Infections like retropharyngeal abscess also precipitate acute torticollis through inflammatory muscle contracture and pain.^[31] Torticollis frequently co-occurs with other conditions in infants, amplifying mutual risks. Infants with developmental dysplasia of the hip (DDH) show a higher association with CMT, as both stem from similar positional constraints, with DDH noted in 2-29% of CMT cases.^[32] Similarly, plagiocephaly is prevalent alongside torticollis, with studies indicating co-occurrence in 20-40% of infants, where head tilting exacerbates skull deformation and vice versa.^[33]^[34]

Pathophysiology and Anatomy

Neck Anatomy

The neck's skeletal framework consists of seven cervical vertebrae, designated C1 through C7, which form a flexible column supporting the skull and enabling a wide range of head movements while protecting the spinal cord and neurovascular structures.^[35] The atlas (C1) articulates with the occipital condyles of the skull, allowing for nodding motions, while the axis (C2) features the odontoid process that facilitates rotation; the remaining vertebrae (C3-C7) provide progressive lordosis for balanced posture.^[35] Proper alignment of these vertebrae is essential for maintaining neutral head position relative to the torso.^[36] Key muscles of the neck include the sternocleidomastoid (SCM), scalenes, trapezius, and splenius capitis, which collectively control head tilt, rotation, flexion, and extension. The SCM originates from the anterior surface of the manubrium sterni and the medial third of the clavicle, inserting on the mastoid process of the temporal bone and the lateral half of the superior nuchal line of the occipital bone.^[37] The anterior scalene arises from the anterior tubercles of the transverse processes of C3-C6 vertebrae and inserts on the scalene tubercle of the first rib, while the middle and posterior scalenes originate from C2-C7 transverse processes and attach to the first and second ribs, respectively.^[38] The trapezius muscle's upper fibers originate from the superior nuchal line, external occipital protuberance, and ligamentum nuchae, inserting into the lateral third of the clavicle, acromion, and scapular spine.^[39] The splenius capitis originates from the lower half of the ligamentum nuchae and the spinous processes of C7-T3/4 vertebrae, inserting into the mastoid process and superior nuchal line.^[40] Motor innervation to the SCM is primarily provided by the spinal accessory nerve (cranial nerve XI), with additional proprioceptive input from the ventral rami of C2 and C3.^[37] The scalene muscles receive motor supply from the anterior rami of C3-C8 spinal nerves via the cervical and brachial plexuses.^[38] The trapezius is innervated by cranial nerve XI for its primary motor function, supplemented by C3-C4 rami for sensory and minor motor contributions.^[39] Splenius capitis is supplied by the dorsal rami of C1-C3 spinal nerves.^[40] Sensory innervation to the neck's skin and superficial structures derives from the cervical plexus, formed by the anterior rami of C1-C4, which provides cutaneous branches such as the lesser occipital, great auricular, transverse cervical, and supraclavicular nerves.^[41] The vertebral arteries, branches of the subclavian arteries, course through the transverse foramina of the cervical vertebrae from C6 to C1, ascending alongside the spinal cord before piercing the dura to enter the foramen magnum and form the basilar artery.^[42] This path underscores the intimate relationship between vascular supply and skeletal alignment in the neck. In terms of biomechanics, normal head rotation involves coordinated contraction of the contralateral SCM to turn the head ipsilaterally, coupled with ipsilateral tilt via the same muscle, while the splenius capitis and upper trapezius assist in extension and stabilization; the scalenes contribute to lateral flexion during combined movements.^[43]

Pathophysiological Mechanisms

In congenital muscular torticollis (CMT), the primary pathophysiological mechanism involves fibrosis of the sternocleidomastoid (SCM) muscle, often initiated by hematoma formation in utero due to birth trauma or vascular compromise, leading to localized bleeding and subsequent shortening of the muscle fibers.^[17] This hematoma triggers an inflammatory response that promotes excessive collagen deposition within the endomysium, resulting in fibrotic contracture and restricted neck rotation, as evidenced by histopathological analyses showing dense collagen bundles replacing normal muscle architecture.^[4] Recent 2025 reviews confirm this process, and biopsy studies have shown fibrosis occupying 46-55% of the SCM muscle area across different age groups in CMT patients, perpetuating the ipsilateral head tilt and contralateral rotation.^[23]^[44] In spasmodic torticollis, a form of focal cervical dystonia, the underlying mechanism stems from basal ganglia dysfunction, which disrupts normal motor control and generates aberrant signaling through extrapyramidal pathways, leading to involuntary dystonic spasms in neck muscles such as the SCM and trapezius.^[45] This hyperactivity in the direct basal ganglia pathway inhibits the indirect pathway, resulting in unbalanced thalamo-cortical output that amplifies muscle contractions and sustains abnormal postures without structural muscle changes.^[46] Functional neuroimaging studies demonstrate reduced inhibition in these circuits, contributing to the phasic or tonic spasms characteristic of the condition.^[47] Ocular torticollis arises from compensatory mechanisms in response to trochlear nerve (cranial nerve IV) palsy, where weakness of the superior oblique muscle causes vertical diplopia and torsional misalignment, prompting an involuntary head tilt to the contralateral side for binocular fusion and alleviation of double vision.^[48] This adaptive posture minimizes the hypertropia in the affected eye by aligning the visual axes through vestibular-ocular reflex adjustments, though prolonged tilting can secondarily strain cervical muscles.^[49] Acquired forms of torticollis often involve inflammatory pathways that induce muscle spasms via cytokine release or direct neural irritation, particularly in response to localized infections or space-occupying lesions in the neck region.^[17] Pro-inflammatory cytokines such as interleukin-6 and tumor necrosis factor-alpha, elevated in inflammatory myositis or retropharyngeal processes, sensitize nociceptors and promote sustained contraction in cervical musculature, exacerbating the dystonic posture. Neural irritation from compressive effects, such as those from tumors or abscesses, further activates reflex arcs in the spinal cord, amplifying spasm without primary basal ganglia involvement.^[50] Across torticollis variants, neurological integration plays a key role through disrupted proprioceptive feedback loops, where altered sensory input from neck mechanoreceptors fails to correct abnormal postures, reinforcing the tilted position via maladaptive sensorimotor integration in the brainstem and cortex.^[51] This dysfunction impairs the vestibulocerebellar calibration of head orientation, leading to persistent reliance on faulty afferent signals that sustain the clinical presentation.^[52]

Causes

Congenital Causes

Congenital muscular torticollis (CMT), the most common form of congenital torticollis, frequently originates from intrauterine malposition of the fetus, where restricted space in the uterus—often due to multiple gestation, oligohydramnios, or maternal pelvic shape—causes unilateral compression and stretching of the sternocleidomastoid (SCM) muscle.^[4] This malposition leads to muscle injury, potentially resulting in compartment-like syndrome or early fibrosis, and is considered the leading etiology in a substantial proportion of cases, with some studies favoring it over perinatal factors.^[22] Risk factors include breech presentation and firstborn status, which exacerbate uterine crowding during late pregnancy.^[53] Birth trauma during delivery constitutes another major congenital cause, particularly in cases involving difficult labor such as breech extraction or forceps use, which can produce a unilateral hematoma within the SCM muscle.^[17] Associated injuries like clavicular fracture may further contribute to localized bleeding and subsequent organization of the hematoma into avascular fibrous tissue, shortening the muscle and tilting the head.^[54] Although historically emphasized, this mechanism is now viewed as less prevalent than intrauterine factors in most CMT presentations.^[27] Vascular compromise theories suggest that ischemic events to the SCM, arising from arterial occlusion, venous congestion, or prolonged compression during delivery, underlie some cases of congenital torticollis by triggering muscle necrosis and reparative fibrosis.^[55] Supporting evidence includes ultrasound detection of hypoechoic pseudotumors in the affected muscle, indicative of early ischemic damage rather than acute hemorrhage.^[13] These vascular insults may overlap with malposition effects, promoting the histopathological changes observed in CMT.^[56] A fibrotic basis is evident in fibromatosis colli, a benign, self-limiting proliferation of fibroblastic tissue within the SCM that represents the pathological hallmark of many congenital torticollis cases, and a palpable mass is present in approximately 30-50% of affected infants.^[13] This condition arises from disorganized muscle repair following the aforementioned injuries, without malignant potential or genetic predisposition in most instances.^[57] Genetic factors are rarely implicated, with familial recurrence limited to isolated reports.^[58] Congenital torticollis often co-occurs with other musculoskeletal anomalies, notably developmental dysplasia of the hip in up to 20% of cases and clubfoot in a smaller subset, suggesting shared intrauterine constraints or connective tissue vulnerabilities.^[4] These associations underscore the need for screening in diagnosed infants.^[59] Other forms of congenital torticollis, less common than CMT, include non-muscular causes such as skeletal anomalies (e.g., Klippel-Feil syndrome, vertebral malformations, or unilateral atlantooccipital fusion), ocular torticollis due to congenital nystagmus or strabismus, and positional deformation from prolonged intrauterine positioning.^[4]

Acquired Causes

Acquired torticollis arises from postnatal environmental, traumatic, or secondary medical factors that disrupt normal neck muscle function or cervical spine alignment, often presenting as reversible or treatable conditions in contrast to developmental origins. These causes typically manifest later in life or after specific exposures, leading to involuntary neck tilting or rotation through mechanisms such as inflammation, imbalance, or neural disruption. Common triggers include infections, injuries, medications, neurological disorders, and gastrointestinal or psychological factors. Infectious etiologies often involve deep neck space infections or upper airway processes that provoke muscle spasm and irritation. Retropharyngeal abscess, a bacterial infection in the retropharyngeal space, frequently causes torticollis through local inflammation, swelling, and secondary muscle contracture, presenting with neck stiffness and pain alongside fever and dysphagia.^[31] Upper respiratory infections, such as viral pharyngitis or streptococcal tonsillitis, can induce reactive cervical lymphadenopathy, leading to muscular irritation and acute torticollis as the body responds with protective posturing.^[60] Traumatic causes stem from direct or indirect injury to the cervical region, resulting in muscular imbalance or soft tissue damage. Whiplash injuries, commonly from motor vehicle accidents, involve rapid hyperextension and flexion of the neck, which can strain sternocleidomastoid and trapezius muscles, producing persistent torticollis due to spasm and inflammation.^[61] Similarly, cervical spine injuries, such as fractures or sprains from falls or sports, disrupt normal biomechanics and lead to compensatory muscle guarding that manifests as acquired torticollis.^[62] Iatrogenic factors, particularly medication-related, account for acute-onset cases through pharmacological interference with neurotransmitter balance. High-potency neuroleptics like haloperidol, used in psychiatric or agitation management, induce acute dystonia—including torticollis—in approximately 3-10% of users, often within hours of administration due to dopamine receptor blockade in the basal ganglia.^[63] This reaction is more prevalent in younger males and at moderate to high doses, highlighting the need for monitoring during antipsychotic therapy.^[64] Neurological conditions contribute through central or peripheral disruptions affecting motor control. Posterior fossa tumors, such as medulloblastomas or ependymomas, can compress cerebellar or brainstem structures, resulting in torticollis as an early sign of imbalance in neck posture regulation.^[65] Stroke, particularly involving the basal ganglia or brainstem, may cause neurogenic torticollis by impairing neural pathways that coordinate head position, leading to dystonic posturing on the affected side.^[3] Atlantoaxial instability, which occurs in up to 49% of patients with rheumatoid arthritis, can produce chronic or intermittent torticollis through erosion of ligaments and joints at the C1-C2 level, causing subluxation that irritates surrounding muscles and nerves.^[66] Other acquired triggers include gastrointestinal and psychogenic origins, which are less common but distinct in their mechanisms. Sandifer syndrome, linked to gastroesophageal reflux disease (GERD) or hiatal hernia, manifests as episodic torticollis in infants through dystonic posturing as a reflexive response to esophageal pain during feeding or reflux episodes.^[67] Psychogenic torticollis, arising from underlying psychiatric disorders, presents as functional dystonia with inconsistent symptoms that mimic organic forms but resolve with psychological intervention, accounting for a small subset of non-structural cases.^[68]

Signs and Symptoms

Presentation in Infants

In infants, congenital muscular torticollis (CMT) typically presents with a characteristic head tilt, where the ear on the affected side approximates the ipsilateral shoulder, accompanied by rotation of the chin toward the opposite shoulder.^[69]^[14] This posture results from unilateral shortening or fibrosis of the sternocleidomastoid (SCM) muscle, leading to restricted passive rotation and lateral flexion of the neck to the contralateral side.^[70] Facial asymmetry may develop over time, often manifesting as plagiocephaly, a flattened appearance of the skull on the ipsilateral side due to persistent head positioning.^[71] A palpable firm mass, known as a pseudotumor or fibromatosis colli, within the affected SCM muscle is detectable in up to 50% of CMT cases, usually appearing between 2 and 8 weeks of age and resolving spontaneously by 4-8 months.^[4] This mass represents benign fibrous proliferation rather than a true neoplasm and is more commonly located in the lower third of the muscle.^[25] Functionally, infants with CMT often exhibit positional preferences, such as favoring one side during sleep or play, which exacerbates skull flattening and may contribute to delayed motor milestones, including difficulty rolling over or achieving symmetrical head control.^[69]^[72] Feeding challenges are common, with infants struggling to latch or breastfeed effectively on the affected side due to limited neck mobility and discomfort.^[14] These presentations are primarily linked to congenital etiologies involving SCM injury or malformation during birth.^[7]

Presentation in Adults

In adults, torticollis, often manifesting as cervical dystonia or spasmodic torticollis, typically presents with involuntary contractions of the neck muscles leading to abnormal head postures and movements. This condition is usually acquired and chronic, differing from congenital forms by its onset in mid-adulthood and association with dystonic features rather than fixed positioning. Symptoms can vary in severity but commonly involve a combination of motor, sensory, and psychological elements that significantly disrupt daily functioning.^[5]^[73] The pain profile in adult torticollis is characterized by aching discomfort in the neck that frequently radiates to the shoulders and upper back, affecting up to 76% of patients due to sustained muscle contractions and abnormal postures. In spasmodic cases, this pain is often exacerbated by emotional stress or physical fatigue, with over 80% of individuals reporting worsening during periods of heightened self-consciousness or exhaustion.^[74]^[75] Motor limitations arise from intermittent spasms that produce jerky, involuntary head movements, tremors, or persistent pulling sensations toward one side, resulting in restricted range of motion and abnormal tilting or rotation of the head. These dystonic contractions can be sustained, leading to fixed postures, or phasic, causing repetitive twisting motions that intensify during activities like walking.^[5]^[76]^[77] Sensory aspects include frequent headaches stemming from muscle tension, occasional dizziness, and dysphagia in cases with pronounced head turning that affects swallowing mechanics. These symptoms contribute to overall discomfort and may prompt medical evaluation when accompanied by other neurological signs.^[3]^[78]^[79] Psychosocial effects are prominent, with many patients experiencing embarrassment from visible head abnormalities, leading to social withdrawal and avoidance of public interactions. Many patients with spasmodic torticollis report substantial quality-of-life impairments, often tied to non-motor symptoms like anxiety and depression that amplify the condition's burden.^[80]^[81]

Diagnosis

Clinical Assessment

The clinical assessment of torticollis begins with a detailed history to determine the onset, progression, and potential etiology. Clinicians inquire about the timing of symptom onset, distinguishing congenital cases noted shortly after birth from acquired forms that may develop suddenly or gradually later in life. A history of trauma, such as birth-related injury or recent neck strain, is elicited, along with family patterns, as congenital muscular torticollis (CMT) can have a familial component in rare instances. Associated symptoms are carefully documented, including pain, fever, vomiting, irritability, or neurological deficits like ataxia or weakness, which may indicate underlying conditions beyond muscular causes.^[82]^[3]^[83] Physical examination focuses on posture and neck mobility to characterize the deformity. Observation reveals characteristic head tilt toward the affected side with contralateral chin rotation, often accompanied by facial asymmetry if chronic. The sternocleidomastoid (SCM) muscle is palpated for fibrosis, thickening, or a palpable mass, present in approximately one-third of congenital cases. Cervical range of motion (ROM) is measured actively and passively; normal rotation is approximately 80° bilaterally, with restrictions typically exceeding 15-20° indicating significant involvement.^[14]^[84]^[82] Neurological screening is essential to identify central or dystonic etiologies. A complete exam assesses cranial nerve function, checking for strabismus, nystagmus, or other focal deficits that may suggest posterior fossa pathology. In adults with suspected spasmodic torticollis (cervical dystonia), standardized scales like the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) evaluate severity, disability, and pain, with total scores ranging from 0 to 85 for comprehensive assessment.^[3]^[85]^[86] Red flags warranting urgent evaluation include sudden onset, fever, progressive neurological symptoms, or signs of increased intracranial pressure, as these may signal infection, malignancy, or vascular issues rather than benign muscular torticollis.^[87]^[88]^[89]

Diagnostic Tests

Ultrasound serves as the first-line imaging modality for diagnosing congenital muscular torticollis (CMT), particularly in infants, where it effectively visualizes sternocleidomastoid (SCM) muscle involvement.^[89] It reveals characteristic findings such as SCM thickening greater than 4 mm, often accompanied by hyperechoic regions indicating fibrosis or pseudotumor formation, with a sensitivity exceeding 90% for detecting clinically significant CMT.^[90] This non-invasive test is preferred due to its availability, lack of radiation exposure, and ability to assess muscle texture and vascularity via Doppler, aiding in differentiation from other neck masses.^[91] For acquired torticollis, magnetic resonance imaging (MRI) and computed tomography (CT) are essential to exclude underlying structural pathologies such as tumors, abscesses, or cervical spine abnormalities.^[3] MRI provides superior soft tissue contrast to identify neural compression, inflammatory processes, or vascular anomalies, while CT excels in detecting bony deformities or calcifications.^[92] According to 2025 pediatric neck imaging guidelines, MRI is recommended for cases of spasmodic torticollis to rule out secondary structural lesions, especially when clinical red flags suggest non-muscular etiologies.^[93] Electromyography (EMG) is particularly valuable in evaluating spasmodic torticollis, a form of cervical dystonia, by characterizing abnormal muscle activity patterns.^[94] Surface or needle EMG recordings demonstrate co-contraction of antagonist neck muscles, overflow activity, and irregular firing rates, helping to confirm dystonic etiology and guide targeted interventions.^[95] These findings distinguish spasmodic torticollis from other movement disorders, with studies showing consistent patterns of sustained bursts in affected sternocleidomastoid and trapezius muscles.^[96] Additional diagnostic tests include plain X-rays for assessing bony subluxation, such as atlantoaxial rotary displacement, which may present with acute torticollis and require dynamic views to evaluate alignment.^[97] In cases of suspected familial dystonias contributing to torticollis, genetic testing targets mutations in genes like TOR1A (DYT1) or THAP1 (DYT6), recommended when a positive family history indicates hereditary forms.^[94]^[98]

Treatment

Physical and Manual Therapies

Physical and manual therapies serve as first-line, non-invasive treatments for torticollis, focusing on restoring neck range of motion (ROM), reducing muscle tightness, and promoting symmetrical posture through targeted rehabilitation techniques.^[99] These approaches are particularly effective for congenital muscular torticollis (CMT) in infants and spasmodic torticollis in adults, with evidence indicating improved outcomes when initiated early.^[100] Stretching exercises target the sternocleidomastoid (SCM) muscle, involving passive stretches where the caregiver gently tilts and rotates the infant's head toward the affected side. Typical protocols recommend holding each stretch for 30 seconds, repeating 3 to 5 times per session, and performing sessions 3 to 5 times daily to elongate the shortened muscle and prevent contracture progression.^[101] In CMT cases, early physical therapy intervention before 3 months of age leads to shorter treatment durations (e.g., averaging 1.5-5.9 months compared to 7.2 months for starts at 3-6 months) and better outcomes, including higher rates of full resolution.^[102] Positioning strategies complement stretching by encouraging natural head movement and counteracting preferential turning. For infants, supervised tummy time—starting with short sessions totaling 15-30 minutes daily by 2 months—combined with placing toys or mirrors on the non-preferred side promotes active rotation and strengthens neck extensors.^[103] In adults with acquired torticollis, posture training uses full-length mirrors to provide visual feedback during daily activities, helping patients self-correct head tilt and maintain neutral alignment, thereby reducing compensatory strain on adjacent muscles.^[104] Manual therapy techniques, such as soft tissue mobilization and myofascial release, involve gentle massage and sustained pressure on the SCM and surrounding fascia to break down adhesions and enhance tissue extensibility. These interventions, often integrated into physical therapy sessions 2-3 times weekly, have demonstrated efficacy in significantly improving cervical ROM, particularly when combined with stretching.^[105] Home-based exercises are critical for maintaining gains from supervised physical therapy in cervical dystonia, with structured programs combining clinic and home components resulting in significant reductions in dystonia severity.^[106] As of 2025, telehealth approaches, including tele-yoga, have demonstrated feasibility for managing cervical dystonia, potentially improving access and adherence in adult patients.^[107] Early intervention through these therapies correlates with favorable long-term prognosis, as detailed in subsequent sections.^[100]

Pharmacological and Injectable Treatments

Pharmacological treatments for torticollis primarily target muscle spasms and dystonic activity through oral medications that modulate neurochemical pathways, offering symptom relief in select cases. Anticholinergics, such as trihexyphenidyl, are commonly initiated to reduce involuntary contractions by blocking acetylcholine at muscarinic receptors, particularly effective in pediatric or early-onset forms where higher doses may be tolerated. These agents may provide modest symptom relief in some patients with dystonia, though efficacy is limited in adults and often requires high doses with side effects.^[108] Benzodiazepines, like clonazepam or diazepam, provide adjunctive muscle relaxation and anxiolytic benefits, enhancing spasm control when combined with anticholinergics, but with variable response.^[108] These oral options are often trialed before more invasive interventions, with dosing titrated to balance symptom reduction against side effects like dry mouth, cognitive impairment, or sedation. Injectable therapies represent a cornerstone for managing refractory or spasmodic torticollis, directly targeting overactive muscles to interrupt dystonic signals. Botulinum toxin type A (BoNT-A), administered via intramuscular injections into the sternocleidomastoid (SCM) and adjacent neck muscles such as the trapezius or splenius capitis, induces localized chemodenervation for 3-4 months per cycle. Meta-analyses and clinical reviews confirm substantial benefits, with 70-90% of patients experiencing meaningful improvement in head position, pain, and disability scores on scales like the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). Electromyography (EMG)-guided injections enhance precision, minimizing diffusion to adjacent structures and optimizing outcomes in up to 80% of cases. These treatments are repeated every 12-16 weeks, often complementing physical therapy for sustained gains. For severe contractures unresponsive to standard approaches, chemical neurolysis with phenol blocks offers longer-lasting denervation of affected nerves or motor points in the SCM or posterior cervical muscles. Phenol, injected at concentrations of 5-7% under EMG or ultrasound guidance, produces partial ablation of nerve function, leading to significant reductions in Tsui scores for neck deviation in responsive patients, though effects may persist 6-12 months with variable recurrence. Emerging research into inflammatory components of acquired torticollis suggests potential roles for monoclonal antibodies targeting autoimmune pathways, such as those modulating cytokine activity in secondary dystonias, but clinical application remains investigational with limited evidence. Common side effects of injectable treatments include transient dysphagia, neck weakness, or injection-site pain, occurring in 10-30% of BoNT-A cases and higher with phenol due to its caustic nature; these are mitigated through EMG guidance and dose optimization. Dryness of the mouth or blurred vision may accompany oral anticholinergics, necessitating monitoring in older adults.

Surgical Interventions

Surgical interventions for torticollis are typically reserved for cases where conservative treatments, such as physical therapy and pharmacological options, have failed to achieve adequate improvement. These procedures aim to address underlying structural or neurological issues causing persistent head tilting and rotation. In congenital muscular torticollis (CMT), surgery is indicated if there is no significant progress after at least 12 months of intensive physical therapy. Common techniques include sternocleidomastoid (SCM) tenotomy or Z-plasty lengthening to release the shortened muscle and fascia. These procedures have demonstrated high success rates, with approximately 88% of patients achieving excellent or good outcomes in head position and range of motion.^[109] For spasmodic torticollis, also known as cervical dystonia, surgical options target refractory cases unresponsive to medications or injections. Selective peripheral denervation, such as rhizotomy of affected cervical nerves and muscles, interrupts abnormal signals and provides lasting relief in about 76% of patients with significant symptom reduction. Alternatively, deep brain stimulation (DBS) of the globus pallidus internus offers neuromodulation for severe, medication-resistant cases, achieving 50-70% improvement in dystonic symptoms and disability scores over long-term follow-up.^[110]^[111]^[112] Atlantoaxial fusion is employed for fixed deformities resulting from rotatory subluxation at the C1-C2 joint, often due to chronic instability or trauma. This posterior fusion stabilizes the atlantoaxial articulation, correcting the torticollis and preventing neurological compromise in cases where nonoperative reduction fails.^[97]^[113] Postoperative management universally includes immobilization with a cervical collar for 4-6 weeks to promote healing, followed by structured physical therapy to restore mobility and strength. Recent reviews from 2023-2025 highlight that minimally invasive techniques, such as endoscopic SCM release, are associated with lower complication rates—often under 5% for infection or scarring—compared to traditional open surgery, while maintaining comparable efficacy.^[114]^[115]^[116]

Prognosis and Complications

Prognosis

The prognosis for congenital muscular torticollis (CMT) is generally excellent when physical therapy is initiated early, typically within the first few months of life, with 90% to 95% of affected infants achieving full resolution of symptoms by age one.^[4] Delayed treatment beyond six months increases the likelihood of persistent craniofacial asymmetry and other anatomic changes, potentially requiring surgical intervention in refractory cases.^[4] In spasmodic torticollis, also known as cervical dystonia, the condition is chronic but often manageable with multimodal approaches including botulinum toxin injections, medications, and physical therapy. Long-term control remains variable, with approximately 52% of patients rating their outcomes as good or excellent after sustained therapy.^[117] Acquired torticollis has a variable prognosis depending on the underlying cause, but acute forms—such as those secondary to infection—typically resolve fully with prompt treatment of the etiology, often within 7 to 10 days.^[83] Key factors influencing overall prognosis across torticollis types include the age at onset, with earlier intervention yielding superior outcomes particularly in infants, and adherence to prescribed therapy, which significantly correlates with reduced treatment duration and better resolution rates.^[118]

Complications

Untreated or severe cases of congenital muscular torticollis (CMT) can result in significant musculoskeletal complications, including permanent facial asymmetry due to uneven growth of the craniofacial bones from persistent head tilting.^[4] Additionally, prolonged muscle imbalance may lead to cranial deformation, such as plagiocephaly, where the skull flattens asymmetrically, and secondary scoliosis as compensatory curvatures develop in the cervical and thoracic spine to maintain balance.^[4]^[119] Neurological complications arise primarily from chronic strain in severe or untreated torticollis, particularly in rotational variants. Chronic pain syndromes are common in adults with spasmodic torticollis (cervical dystonia), often involving unilateral neck pain radiating to the shoulders and accompanied by muscle stiffness.^[3] Compensatory headaches frequently occur due to sustained abnormal postures and muscle tension.^[5] In rare instances, rotational torticollis has been associated with vertebral artery dissection, a serious vascular event that can lead to ischemic stroke, as documented in pediatric case reports of recurrent episodes.^[120] Developmental sequelae are particularly notable in infants with untreated CMT, where restricted neck mobility hinders visual exploration and environmental interaction, contributing to motor delays such as postponed achievement of milestones like rolling, sitting, and crawling.^[121] Studies indicate that infants under 10 months with torticollis face an elevated risk of these delays compared to peers without the condition.^[122] In adults with persistent dystonic torticollis, these issues evolve into reduced quality of life, marked by limitations in daily activities, social withdrawal, and heightened emotional distress from ongoing visible deformity and pain.^[123] Iatrogenic complications can emerge from interventions aimed at managing torticollis. Pharmacological treatments like botulinum toxin injections may cause transient neck weakness, dysphagia, or localized pain at the injection site, affecting up to a notable portion of patients in clinical series.^[124] Surgical release of the sternocleidomastoid muscle, typically reserved for refractory cases, carries risks of poor scarring, recurrent deformity requiring reoperation in about 1-2% of instances, and potential injury to the spinal accessory nerve leading to shoulder weakness.^[109]^[12]

Torticollis in Other Animals

Presentation

Torticollis, also known as wry neck, manifests in veterinary patients as an abnormal, involuntary twisting or tilting of the head and neck, often resulting from unilateral muscle contraction or neurological dysfunction. In dogs and cats, it is a frequent clinical sign encountered in general practice, primarily arising from peripheral vestibular disease, otitis media or interna (inner ear infections), or trauma, with the head tilt typically unilateral and accompanied by signs such as nystagmus (involuntary eye movements), ataxia (uncoordinated gait), circling toward the affected side, and reluctance to turn or raise the head.^[125]^[126]^[127] These presentations differ from human cases, where muscular dystonia predominates, by the prominent role of inner ear pathology in small animals, leading to vestibular imbalances that disrupt balance and spatial orientation.^[128]^[129] In rabbits, a common small mammal, torticollis often results from infections such as Encephalitozoon cuniculi (a protozoan parasite) or bacterial causes like Pasteurella, leading to vestibular dysfunction. Affected rabbits display a pronounced head tilt, rolling, or torticollis, frequently with nystagmus and loss of balance, which can progress to paralysis if untreated.^[130]^[131] Vestibular dysfunction, a leading cause of torticollis in dogs and cats, has a reported prevalence of approximately 0.08% among primary veterinary care cases in the UK, though it is more common in presentations involving neurological complaints. Congenital forms, such as those linked to cervical vertebral malformations (wobbler syndrome), occur at higher rates in predisposed breeds like Doberman Pinschers, where up to 80% of such malformations are documented in Dobermans and Great Danes combined.^[132]^[133] In birds, particularly chickens and other poultry, wry neck is frequently observed and typically stems from nutritional deficiencies, such as vitamin E or selenium shortages, or trauma. Symptoms include twisted neck posture, inability to hold the head upright, circling, and star-gazing, often without the vestibular signs prominent in mammals.^[134]^[135] In horses, torticollis presents as wry neck, often stemming from cervical vertebral malformations, trauma, or congenital skeletal defects, and is frequently associated with ataxia due to spinal cord compression or instability. Affected horses exhibit a persistent abnormal neck posture, stiffness, reluctance to flex or turn the head, and gait abnormalities such as stumbling or limb incoordination, contrasting with the more isolated head tilt seen in small animals.^[136]^[137]^[138] This condition shares anatomical parallels with human torticollis in involving asymmetric tension in cervical musculature but is distinguished by its frequent integration with locomotor deficits in equines.^[139]

Management

Management of torticollis in animals emphasizes conservative strategies initially, with surgical options reserved for refractory or structural cases, all adapted to species-specific physiology and ethical considerations such as minimizing stress in exotic or large animals. For infectious causes, such as bacterial otitis media or listeriosis, prompt administration of targeted antibiotics forms the primary treatment, often supplemented with anti-inflammatory medications, vitamins (e.g., B1 and B12), and supportive fluid therapy to address dehydration and neurological symptoms. In small mammals like rabbits and rodents, management includes analgesia (e.g., meloxicam) and anti-nausea agents (e.g., maropitant) to alleviate discomfort and vestibular signs, while in dogs and cats, passive range-of-motion exercises and gentle manipulation mimic physical therapy to reduce cervical muscle spasms without risking injury. For birds, treatment focuses on correcting nutritional deficiencies with vitamin E and selenium supplementation, alongside supportive care. Neck braces or custom cervical collars provide stabilization in pets, restricting excessive head movement to promote healing while allowing basic mobility and vision, particularly useful post-trauma or during acute vestibular episodes. Surgical interventions are indicated for trauma-induced instability, congenital malformations, or chronic infections unresponsive to medical therapy, with techniques tailored to the animal's size and anatomy. In horses, cervical spine stabilization via intervertebral fusion or polyaxial pedicle screw-rod constructs addresses vertebral instability contributing to torticollis, aiming to decompress the spinal cord and restore alignment. For otitis-related cases in rabbits, total ear canal ablation combined with bulla osteotomy effectively eliminates infectious foci in the middle ear. Botulinum toxin injections, which relax dystonic muscles, are infrequently employed in veterinary practice due to prohibitive costs, off-label status, and limited clinical trials demonstrating efficacy in animals. Prognosis in animals with torticollis is generally favorable for infectious etiologies, with good outcomes when treatment is initiated early and the pathogen is susceptible to antibiotics. Idiopathic vestibular cases, however, warrant a more guarded outlook, as spontaneous resolution occurs in many but residual deficits like mild head tilt may persist despite supportive care. Veterinary diagnostics utilize advanced MRI techniques to delineate soft tissue and neural abnormalities, improving targeted management.^[140]

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The clinical severity subscale of the Toronto Western Spasmodic Torticollis Rating Scale can be assessed with good inter-rater reliability when ...
[87]
Teaching tape for the motor section of the toronto western ...
Nov 4, 2004 · The Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) assesses the character and severity of cervical dystonia (CD).
[88]
Red Flags in Torticollis: A Historical Cohort Study - PubMed
Objective: This study aimed to assess the spectrum of pathologies responsible for torticollis ... symptoms to determine clinical red flags for hospitalization.
[89]
Pediatric torticollis: clinical report and predictors of urgency of 1409 ...
Apr 24, 2024 · This study describes the clinical characteristics of a large sample of children with torticollis. The aim of our study was to detect epidemiology, etiology and ...<|control11|><|separator|>
[90]
Torticollis - Knowledge @ AMBOSS
Apr 2, 2025 · Red flags toggle arrow icon · Acute or progressing focal neurologic deficits · Ataxia · Signs of increased ICP · Diplopia · Preceding trauma.Missing: assessment | Show results with:assessment
[91]
The value of high-frequency and color Doppler ultrasonography in ...
Oct 26, 2012 · The sensitivity and specificity of ultrasound in diagnosing CMT was 95.83%, and 83.33%, respectively. The positive likelihood ratio was 5.75 and ...
[92]
Application of ultrasonography in diagnosis and treatment of ... - NIH
Apr 22, 2024 · Homogeneous echo and the sensitivity and specificity of conventional ultrasonography in diagnosing cervical bulky CMT were 95.83% and 83.33%, ...
[93]
Imaging of Torticollis in Children | RadioGraphics - RSNA Journals
Mar 5, 2012 · Congenital torticollis, seen in neonates and infants, usually results from craniocervical vertebral anomalies or muscular causes, although ...Missing: reliable sources
[94]
[PDF] Cigna Pediatric Neck Imaging Guidelines - V1.0.2025 - eviCore
Both CT and MRI assist in diagnosing non traumatic torticollis as a result of atlantoaxial subluxation; CT has the advantage of being readily available, however.Missing: tests | Show results with:tests
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Torticollis Workup: Approach Considerations - Medscape Reference
Jan 4, 2024 · When a positive family history suggests a familial dystonia rather than idiopathic cervical dystonia, DNA tests for specific genetic dystonias ...
[96]
Beyond the Surface: Electromyography in Cervical Dystonia
... EMG recordings can identify characteristic features such as overflow and co-contraction, believed but not confirmed to be indicative of dystonic activity.
[97]
Comparison between 18F-FDG PET/CT and EMG Mapping for ... - NIH
Mapping based on needle electromyography (EMG) is the most widely used method for identifying dystonic muscles in PCD. Needle EMG can detect the abnormal firing ...
[98]
Atlantoaxial Rotatory Displacement (AARD) - Spine - Orthobullets
Jan 13, 2025 · Atlantoaxial Rotatory Displacement is a pediatric cervical spine rotatory instability caused by C1-C2 subluxation or facet dislocation. The ...
[99]
Clinical and genetic features of cervical dystonia in a large ... - NIH
Apr 11, 2016 · Genetic screening. Exon 5 of TOR1A harbors the classic DYT1 ΔGAG mutation, and cosegregating pathogenic SVs have not been identified in other ...
[100]
APTA Pediatrics - Congenital Muscular Torticollis Clinical Practice ...
Congenital muscular torticollis (CMT) is a postural deformity evident shortly after birth, typically presenting as side bending of the neck to one side and ...Missing: triad | Show results with:triad<|control11|><|separator|>
[101]
Congenital Muscular Torticollis: Bridging the Gap Between ...
Congenital muscular torticollis (CMT) is a common postural deformity evident shortly after birth, typically characterized by ipsilateral cervical lateral ...
[102]
Infant Torticollis Stretching Techniques - Kids Plus Pediatrics
Hold this position for 30 seconds, as tolerated by the baby. Repeat 2-4 times. Do this exercise 3-4 times a day.
[103]
A 2018 EVIDENCE-BASED CLINICAL PRACTICE GUIDELINE ...
Congenital muscular torticollis (CMT) is a postural deformity evident shortly after birth, typically characterized by lateral flexion/side bending of the head ...
[104]
Strategies for Working with Children with Torticollis
Jul 18, 2013 · Tummy time: Place the infant on their tummy and place toys to the opposite side of where the infant normally looks. Encourage the infant to ...
[105]
Physical Therapy for Cervical Dystonia
May 17, 2014 · Use tools to provide feedback on body position and posture including mirrors, feedback from others (spouses for example), foam rollers and body ...
[106]
Effectiveness of the Treatment of Physiotherapy in the Congenital ...
All research found benefits associated with soft tissue mobilization, passive stretching techniques and manual therapy of the cervical spine.
[107]
Neurorehabilitation in dystonia care: key questions of who benefits ...
Aug 21, 2025 · Rehabilitation for dystonia focuses on improving functional abilities, reducing pain, and enhancing QoL for individuals affected by the ...
[108]
Outcome of surgical treatment of congenital muscular torticollis
The final overall score showed excellent results in 88.1%, good results in 8.3%, and fair to poor results in 3.6%. The most important factor affecting the ...
[109]
Selective peripheral denervation for the treatment of spasmodic ...
The results of selective peripheral denervation in 50 patients with spasmodic torticollis are presented. Of our patients, 76% reported a significant ...Missing: rhizotomy efficacy
[110]
Bilateral deep brain stimulation for cervical dystonia in patients with ...
Dec 15, 2011 · The 4 patients from Mannheim/Hannover experienced sustained improvement from pallidal stimulation by a mean of 57.5% according to the Toronto ...Missing: interventions | Show results with:interventions
[111]
Evaluation of outcome of different neurosurgical modalities in ...
May 20, 2022 · The mean improvement in total TWSTRS and Tsui scores were 51.2% and 64.8%, respectively, compared with preoperative scores, while the mean ...<|separator|>
[112]
Cervical fusion for adult patients with atlantoaxial rotatory subluxation
Atlantoaxial rotatory subluxation (AARS) is a rare injury of the C1/C2 junction. It is often associated with trauma in adults. Treatment may depend on the ...
[113]
Surgical Treatment of Congenital Muscular Torticollis - NIH
Jul 26, 2023 · All patients in this study exhibited significant improvement within 6 weeks post-surgery, which was bolstered by a period of intensive physical ...Missing: invasive | Show results with:invasive
[114]
Endoscopic minimally invasive treatment of congenital muscular ...
Aug 9, 2024 · This study aimed to investigate the clinical efficacy of minimally invasive endoscopic treatment of children with congenital muscular torticollis (CMT).Missing: care immobilization
[115]
Bipolar sternocleidomastoid partial resection in pediatric... - Medicine
Dec 27, 2024 · Six (66.7%%) of the surgeries were on the right SCM muscle and 3 (33.3%) were on the left. There were no surgical complications. The average ...
[116]
The course of cervical dystonia and patient satisfaction with long ...
Feb 3, 2005 · On a seven-point scale ranging from excellent to worsening, the effect of treatment was scored as excellent or good by 52% of patients and ...
[117]
Factors Influencing the Duration of Rehabilitation in Infants with ...
Jan 16, 2024 · The primary factors influencing the duration of recovery were identified as the presence of body asymmetries and the age at which therapy was initiated.
[118]
Unresolved Congenital Torticollis and Its Consequences: A Report ...
All 3 types of torticollis can lead to secondary changes in shape, such as deformational plagiocephaly (DP), facial scoliosis, and infantile scoliosis, and ...
[119]
Recurrent torticollis caused by dissecting vertebral artery aneurysm ...
We report a child with recurrent torticollis caused by an intracranial dissecting vertebral artery aneurysm. This is a very rare condition in childhood, and it ...
[120]
Are infants with torticollis at risk of a delay in early motor milestones ...
Recently it has been claimed that infants with congenital muscular torticollis (CMT) are at risk of a delay in early motor milestones.
[121]
Are infants with torticollis at risk of a delay in early motor milestones ...
Jun 5, 2009 · It is eye-opening to discover that even healthy infants without neck problems can be at higher risk of developing deformational plagiocephaly ...
[122]
Impact of cervical dystonia on quality of life - PubMed
Cervical dystonia had a significant negative impact on quality of life compared with age-matched general population data.
[123]
Understanding Clinical Effectiveness and Safety Implications of ...
Adverse events reported by children receiving BoNT for the treatment of CMT mainly included bruising, neck pain, transient dysphagia, neck weakness, erythema at ...
[124]
Head Tilt in Dogs: A Clinical Approach | Today's Veterinary Practice
Head tilt in dogs is a clinical presentation that most veterinarians encounter frequently in practice, most often due to dysfunction of the vestibular system.
[125]
Torticollis | Veterian Key
Sep 3, 2016 · Torticollis also known as 'wry neck', results from an involuntary unilateral contraction of the neck muscles causing torsion (twisting) of the neck.
[126]
[PDF] ACUTE HEAD TILTS IN DOGS AND CATS
Head tilt, falling, rolling, leaning, circling, abnormal nystagmus and ataxia commonly result. Clinical signs of vestibular disease may be a result of lesions ...
[127]
Vestibular Disease in Dogs and Cats - Veterinary Partner - VIN
Aug 26, 2024 · Ataxia (lack of coordination without weakness or involuntary spasms - in other words, stumbling and staggering around) · Motion sickness ...
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Dog Head Tilt: Not Just Vestibular Syndrome | Walkerville Vet
Sep 4, 2020 · Notice that when you only look at the symptom of head tilt there are another three common causes: neck pain, focal seizure and otitis externa.
[129]
Clinical signs, MRI findings and outcome in dogs with peripheral ...
May 25, 2020 · Vestibular dysfunction is relatively common in dogs, with a prevalence of 0.08% reported in primary veterinary care in the UK.
[130]
Doberman Pinscher - Cervical Vertebral Malformation Syndrome
It has been reported that 80% of the cervical vertebral malformation cases seen in dogs are in Great Dane and Doberman pinscher breeds. It is recognised as a ...Genetic Welfare Problems Of... · Doberman Pinscher · 1. Clinical And Pathological...
[131]
Birth Defect Disorders of Bones, Joints, and Muscles in Horses
Other skeletal malformations include torticollis (twisted neck), wry nose (twisted nose), spina bifida (incomplete closure of the bones in the spine), and ...
[132]
Torticollis - an overview | ScienceDirect Topics
Vascular lesions, infection with herpesvirus, cerebral nematodiasis, hypovitaminosis A, and toxicoses (e.g., lead poisoning) are less common causes of head tilt ...Missing: triggers | Show results with:triggers
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Equine Cervical Pain and Dysfunction: Pathology, Diagnosis and ...
Feb 6, 2021 · In contrast, older horses with OA of the APJ may have ataxia and have a stiff and painful neck on examination [80], or are presented for neck ...Missing: wry | Show results with:wry
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Equine neurology: focus on the cervical spine - Veterinary Practice
Jun 9, 2021 · The most common neurological symptom that equine vets are presented with are horses that have become ataxic. This may vary from horses that are ...Missing: wry | Show results with:wry