The following are common causes of a wry neck torticollis:
1. Awkward posture during sleep resulting in wry neck upon waking
2. Minor turning of the head or sudden fast turning of the head
3. Vigorous and sudden movement or injury (most common cause of wry neck torticollis in children).
4. Any activity that involves sustained awkward positioning (paramedics, this include working in the back of an Ambulance).
5. Repetitive neck movements
6. Slipped facet joint
7. Herniated disc
8. Viral or bacterial infection may cause inflammation resulting in muscle spasm and a wry neck torticolis.
Differential Diagnosis for Wry Neck Torticollis
Okay, so if a wry neck torticollis is generally fundamentally benign and will eventually self resolve, what are the possible differential diagnosis’ that we should consider that possibly more pathological?
1. The most common of differential diagnosis for wry neck torticollis is a dystonic reaction to medications, such as metoclopramide (maxolon), certain anti-psychotic medications, and anti-depression medications. A thorough history should be taken and any medications recently administered to the patient should be taken to the hospital to identify if they may have caused the reaction.
2. Infection is the more significant potential secondary diagnosis for a person who appears to have a wry neck torticollis. Any infection that is viral or bacterial and significant enough to cause what may appear to be a wry neck torticollis should be considered dangerious. Signs and symptoms include: fever, lethargy, photophobia, and signs of systemic stress such as increased heart rate (tachycardia) and lowered blood pressure (hypotension). Also, any changes in the patient’s cognitive function (level of conscious) should be considered danagerious.