Torticollis, neck pain
Torticollis represents a contracture more or less painful of the neck muscles, which limits rotational movements of the head. Torticollis is a two-dimensional deviation of the head and neck. At the beginning, symptoms include a sensation of discomfort and stiffness in the neck, and the head tilts to one side due to unilateral spastic contraction of the muscles.
Sometimes it is associated with the contraction of muscles on the opposite side of the shoulder or with a muscle spasm that can occur around the mouth. Pain is installed in cervical muscles and disappears during the sleep.
Torticollis may be classified into different types. Congenital torticollis – appears at birth and is caused by abnormal development of the muscle responsible for extension of the neck. Torticollis may occur in fetal life (as determined by the vicious head positions or cervical spine malformations at childbirth (obstetric torticollis).
Spasmodic torticollis is caused by unknown factors. Symptomatic torticollis .. It is the most common form, and it is acquired during lifetime because of injuries, inflammation, paralysis or spasm, scarring or sclerosis.
In order to set the diagnose, the cervical spine is evaluated with a CT scan or MRI and cervical spine films.
The treatment with medication of torticolis should include anti-inflammatory drugs without steroids, and muscle relaxants. Torticollis can be treated with physical therapy which may include stretching, electrical nerve stimulation, and massage. Torticollis in an adult can disappear in less than 3-4 days after rest and after administration of analgesics and muscle relaxants and ointments.
Treatment of congenital torticollis is necessary to prevent asymmetric growth of the child and to correct limited mobility of the neck and head. Congenital torticollis is treated by medical gymnastics (physical therapy) designed to stretch the neck muscles.
If the doctor considers that the case of torticollis may be treated only by surgery, than a prior EMG is good for establishing the muscles and nerves that have to be operated. The surgery may involve the release of : unipolar sternocleidomastoid ( a week after the surgery manual stretching is needed ), bipolar sternocleidomastoid (it is possible to use a cervical collar ), dorsal cord stimulation or selective denervation. The surgery may undergo some complications like numbness, the deformation of the neck, injuries of the spinal nerve, sensory loss and pain.
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