Torticollis - stiff neck

Stiff neck or torticollis is a condition in which the head is bent to the right or left side and the chin is directed towards the contralateral neck-extension. Torticollis can be congenital or benefit.
Congenital muscular torticollis has an unclear etiology. Trauma at birth and intrauterine malpozitia are also considered to cause damage to the sternocleidomastoid muscle at the neck. The result is a shortening or excessive contraction of the muscle, which limits the movement of rotation and lateral bending. The head is typically directed laterally towards the affected muscle and rotated toward the opposite.
The reported incidence of congenital torticollis is 2%. Sometimes it may reveal a palpable mass of muscle, which occurs at the age of 2-4 weeks, gradually disappears or cause muscle fibrosis.Usually disappears at the age of 5-8 months of life.The condition is treated initially with physical therapy with stretching to correct stiffness to regain muscle balance to boost symmetry. You can use a special collar. 5-10% of cases require surgery.
Other causes are more random and tumors, infections, eye problems require exclusion. In general if torticollis is not corrected facial asymmetry. Head position must be corrected before adolescence. Treating children proves the best results. Congenital torticollis develops in children, but adults can be diagnosed in ages.
Won torticollis occurs in previously healthy individuals. Neck trauma can cause rotator atlantoaxiala subluxation, in which the two vertebrae at the base of the head slip destabilize ligaments.The condition is treated with traction to reduce the subluxation, followed by ghipsaj tijare or ligament injuries heal up. Skull base tumors may compress nerves and cause neck torticollis. These problems should be treated surgically.
Infections posterior pharynx can irritate nerves and cause torticollis neck muscles, these infections can be treated with antibiotics if they are not severe, but may require surgical debridement.Surgical removal of ear infections and tonsillitis may cause Grisel's syndrome, an upper cervical joint subluxare inflammatory ligament laxity caused by infection. Use of drugs such as antipsychotics can cause torticollis.
Conservative treatment involves medical therapy.Sternocleidomastodiana fibrosis resolves spontaneously in most patients. Psychotherapy may be recommended, however there is evidence that this would change the evolution of the condition.Botulinum toxin type A is injected into muscle for treating sternocleidomastodian congenital torticollis. 5% of patients are treated surgically by releasing the muscle or denervation.
Pathogenesis and causesPathophysiology of spasmodic torticollis is unknown. It considered the nature of neurochemical and neurodegenerative changes do not result from structural. Although basal ganglia lesions are present studies indicate a functional disorder in the globus pallidus control more of the substance nigra. The studies involve the inhibition of cortical areas hiperactivare reduced pallidus. He suggested an imbalance of neurotransmitters such as dopamine, acetylcholine and gammaaminobutiric acid. They are secreted in the basal ganglia and migrate to the neck muscles. An increase in the neurotransmitters that appear to cause neck spasms.
Congenital torticollis is thought to be caused by local trauma to the soft tissues of the neck before or during birth. Most common explanations include birth trauma resulting in hematoma and muscle contracture. These children suffer forceps application.Muscle fibrosis may be due to venous occlusion pressure on the neck and in the birth canal or due to perinatal compartment syndrome. Another hypothesis includes malpozitia in utero or in utero resulting in perinatal compartment syndrome. Up to 20% of children have congenital torticollis congenital dysplasia of the thigh.
Signs and symptoms in torticollisOnset idiopathic torticollis occurs when the patients were 30-50 years old. Traumatic cervical dystonia onset occurs several days from acute and 3-12 months after injury to form late. Onset in childhood suggests a congenital form.Spasmodic torticollis:It is a chronic neurological disorder that causes involuntary neck stiffness on the right, left, superior or inferior. The condition is known as cervical dystonia. Agonist and antagonist muscles contract simultaneously during dystonic movements. Case is predominantly idiopathic disease, a small number of patients develop the disorder as a result of other diseases. Most patients who experience symptoms for the first time at age 50. Treatment of spasmodic torticollis is used for injection of botulinum toxin type A.Spasmodic torticollis initial symptoms are mild. The head may bind certain position or express intro involuntary jerky movements.While voluntary muscle spasms in the neck will increase in frequency and severity until reaching a plateau. Symptoms may worsen while you walk or during periods of increased stress. Other symptoms include muscle hypertrophy, sore throat, tremor.
Classification torticollis:Spasmodic torticollis is a form of local dystonia, a disorder described by sustained muscle contractions forcing twisting and repetitive movements and abnormal positions of a single region of the body. After the initial onset of disorder is classified if the patient is diagnosed before 27 years belated. Cases are classified as idiopathic or secondary.Torticollis PrimaryPrimary torticollis is defined as having no other fault than dystonic movements of neck and occasional tremors. This type of spasmodic torticollis is usually inherited.Secondary torticollis:When other diseases leading to it is called secondary torticollis.These conditions include the following:-Perinatal brain injury, cerebrovascular disease-Drug cases, central nervous system tumorsPeripheral or central-trauma, or infectious encephalopathies postinfectioase-Toxic, metabolic syndromes paraneoplazice, central pontine mielinoliza.
Head positions:To classify spasmodic torticollis head position can be noted.Torticollis is horizontal head rotation and uses and sternocleidomastodian splenius muscle. This is the version of "chin to shoulder."Laterocolis head is moving sideways. This is the version of "ear to shoulder." It involves more muscle: sternocleidomastodian, splenius, scalene, and paravertebralii levatorul scapula.Neck flexion (above) is anterocolisul. The version on the chest and chin is the most difficult. Sternocleidomastodienii uses lateral movement, scalenii, submental complex.Retrocolisul is the extension of the head and uses muscles spleniu bilateral trapezoidal paravertebralii. The version of "chin in the air.Many patients experience combinations of these versions.Congenital torticollis:The first sign may be congenital form firm painless enlargement of the sternocleidomastoid muscle visible at birth. This table, which is located near the muscle insertion expands to six weeks of life and then decreases in size. By the age of 4-6 months is usually absent table and the only clinical observation is sternocleidomastodian muscle contracture and stiff neck position.Psychological factors of depression and anxiety may also play a role.Posttraumatic torticollis:It is classified into two subtypes: acute-onset in a few days after trauma and 12 months late. Features include posttraumatic torticollis acute local pain immediately after trauma: contusions or acceleration-deceleration injury, followed in a few days of marked limitation of neck movements and abnormal head position, shoulder elevation and hypertrophy TRAPEX. Two features distinguish the form of late posttraumatic acute: symptoms do not grow in intensity and no effort in response to sensory trick.