A wry neck torticollis can occur in adults, but is primarily seen in children and involves the sudden spasm or contraction of the muscles in one side of the neck (most commonly the sternocloidomastoid and trapezius) resulting in a very rigid, sometimes painful neck leaning to one side quite dramatically.
Signs and Symptoms of a Wry Neck Torticollis
Although the acute wry neck is reasonably common it can be extremely painful and quite scary for those who have never experienced it before. For the paramedic who has never seen a wry neck torticollis, he or she may think the child is playing a game or making a joke, but it is important to take the disorder seriously. The following are common causes of a wry neck torticollis:
1. Pain is typically one-sided and may be described as sharp or spasmodic (like a cramp).
2. Pain located in the neck muscles or referred down the spine, from the occiput to between the shoulder blades
3. Inability to turn the head to the painful side
4. Maybe a postural deformity (head tilted away from the painful side) due to pain and spasm
5. Inability to straighten head.
6. Anxiety and frustration may occur as the child recognises that he or she can not adjust the position of their head.
7. Vital signs should remain normal throughout.
Wry Neck Torticollis Treatment
A wry neck torticollis will usually self resolve given enough time and patience. The following medical interventions may be required or may help. As paramedics, our aim is primarily to reassure the patient and provide analgesia if required.
1. Reassurance is vital with these patients, especially if they have never had a wry neck torticollis before.
2. Manual traction in the line of the deformity (for apophyseal wry neck)
3. Manual traction away from the pain (for discogenic wry neck)
4. Mobilisation of the joint (only for apophyseal, not for discogenic)
5. Trigger point release
6. Soft tissue massage
7. Active range of motion exercises
8. Stretching exercises
9. Exercises to improve flexibility, strength, posture and core stability
10 Ergonomic advice
11. Postural care and correction
12. Medications for pain management.
13. In extreme cases muscle rellaxant may be required.
14. Attempts to reduce muscle spasm by applying a hot or cold pack.
15. Education for both the child and the parents is vital if they have never seen this before it may appear very frightening.
Would you like to know more about the types of wry neck torticollis that occur?