Wry neck/Torticollis.




Wry neck is defined as rotational deformity of cervical spine , that causes turning and tilting deformity of head and neck.

✓ (Tortus – twisted , Collum – neck.)

✓ Sternocleidomastoid undergoes contracture.

• Causes


✓ Congenital – Infantile torticollis.

✓ Infective – Tb of cervical spine , acute respiratory tract infection.

✓ Traumatic – Sprain, dislocation and fracture of cervical spine.

✓ Myositis of Sternocleidomastoid.

✓ Spasmodic : Painful , persistent or intermittent Sternocleidomastoid contracture.

✓ Unilateral muscle paralysis : polio

✓ Neuritis of spinal accessory nerves.

✓ Occular disturbance.

✓ Birth trauma : Breech delivery, improper application of forceps.

• Pathoanatomy


✓ A lump may be felt in Sternocleidomastoid.

✓ Often localized near the clavicular attachment of Sternocleidomastoid.

✓ Attains maximum size within 1-2 months and usually disappears within 1 year.

✓ If it fails to disappear , then the muscle becomes permanently fibrotic , and contracted and causes torticollis.

• Clinical features


✓ Head of the patient is tilted towards the affected side, while the chin points on other side.

✓ Sternocleidomastoid is prominently seen on other side.

✓ In later stages, patient may develop facial asymmetry and muscular disturbances in the eye.

• Types


(1) Temporary torticollis

(2) Fixed torticollis

(3) Muscular torticollis.

(4)Klippel feil syndrome.

(5) Cervical dystonia.

• Management


(1) Conservative

– Initially conservative treatment is done

– It consists of NSAID’s , muscle relaxants etc.

– Physiotherapy treatment like ultrasound, massage , heat

– In acute pain, the patient is encouraged to wear a cervical collar.

– Gradual neck stretching exercises , passive stretching , and splinting.

– In severe contracture of Sternocleidomastoid,  release of muscle is required from it’s lower attachment.

– Active measures : head movement
Prone lying with head turned toward affected side.

– Massage can help to relax the muscle.

– Maintainace of correction is necessary.

– Same maneuver can be repeated.

– PNF : pattern of neck extension can be used

– Home treatment .

(2) Surgical treatment


– Subcutaneous tenotomy is done

– The clavicular and sternal heads of Sternocleidomastoid are divided close to origin along with release of tight fascia.

– Head is then immobilized in a callot’s  cast in over corrected position for 2-4 weeks .

– Mobilization is began as soon as the cast is removed.

– For older children / often failed operation,  Bipolar release of muscle from both sides, ferkei’s modified bipolar release or z-plasty.

– In infants : surgery is delayed till fibroma is well formed .


• PT management following surgery.


– Since the contracture is removed surgically , passive sustained stretching is not necessary .

– Following measures should be done.

(1) Control of pain : pain relieving modality like hot packs and IRR.

(2) Active movements : free active movements.

(3) Self correction.

(4) Collar : cervical collar.

(5) Working posture .





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