the Causes and Complications of Torticollis: A Comprehensive Guide

Regarding torticollis?

Hello, doctor.
I would like to ask about the causes of torticollis.
In the past year or two, I have been experiencing significant pain, stiffness, and pulling sensations from my head down to my neck and back, particularly in my face and ears.
Initially, during high school, I often felt stiffness in my shoulders, but it wasn't painful.
I suspected it might be due to overexertion from sports (I often played basketball), but I didn't pay much attention to it for many years.
It wasn't until I enlisted in the military two years ago that I began to feel more pain and discomfort.
Sometimes it occurs once or twice a week, but it has become increasingly frequent, and now I feel uncomfortable most of the day, to the point where I can't lie down comfortably, which has affected my sleep.
Recently, I visited a hospital outpatient clinic, and the doctor casually advised me not to maintain any posture for too long and to move around more often.
While this advice is indeed helpful, sometimes even slight movements can cause pain.
Additionally, due to the pain and sleep issues, my mental state has been declining.
I've also noticed that my body is not balanced; my head often tilts slightly to the right without me realizing it, and my jaw is slightly misaligned to the right (malocclusion).
My right chest area is also more concave than the left (a military doctor diagnosed me with thoracic deformity during my service).
I'm unsure if this is a contributing factor.
I would like to clarify the relationship between these symptoms: is the torticollis caused by the thoracic deformity, leading to the misalignment and pain in my jaw, or is the torticollis causing other complications? Thank you.

liú, 20~29 year old female. Ask Date: 2007/07/11

Dr. Yin Xinbei reply Rehabilitation

Torticollis is typically caused by muscle stiffness in the neck, resulting in the head tilting to one side.
In rare cases, it may be due to skeletal, neurological, or soft tissue inflammation in the neck (such as lymphadenitis) or visual abnormalities.
The exact cause of muscle stiffness remains undetermined, but it is hypothesized to be related to muscle ischemia (arterial or venous embolism) or muscle injury.
The commonly referred torticollis in infants is characterized by a neck mass, but based on your described symptoms, it seems to be caused by myofascial pain syndrome, leading to muscle fibrosis and tightness.
The underlying cause may indeed be due to thoracic deformities resulting in an imbalance of muscle tone on both sides of the body, compounded by improper sitting and standing posture.
Your condition appears to be quite severe, and if left untreated, it may continue to worsen and affect your back.
It is advisable to seek consultation with a nearby rehabilitation physician as soon as possible.
The etiology of myofascial pain syndrome is quite complex, and treatment can be challenging, requiring a multifaceted approach involving medication, rehabilitation, exercise, diet, and sleep.
Additionally, it is recommended that you consult a dentist to address any malocclusion issues, as improper bite can also contribute to myofascial pain in the face and neck.
Finally, I suggest searching online for "myofascial pain syndrome" for a deeper understanding.
Here are three articles for your reference:
http://www.kgh.com.tw/health/12-13.html
http://depart.femh.org.tw/rheumatology/fibromyalgia.htm
http://hospital.kingnet.com.tw/essay/essay.html?pid=13111&category=%E8%AD%B7%E7%90%86%E7%85%A7%E8%AD%B7&type=

Reply Date: 2007/07/11

More Info

Torticollis, commonly referred to as "wry neck," is a condition characterized by an abnormal, asymmetrical head or neck position. The causes of torticollis can be multifactorial, and understanding these causes is crucial for effective management and treatment.

Causes of Torticollis
1. Congenital Torticollis: This condition is often present at birth and is typically due to a shortening of the sternocleidomastoid muscle, which can occur during delivery or as a result of positioning in utero.
2. Acquired Torticollis: This can develop later in life and may result from various factors:
- Muscle Strain: Overuse or injury to the neck muscles, often due to repetitive activities or poor posture, can lead to muscle spasms and pain.

- Neurological Conditions: Conditions such as cervical dystonia (a neurological movement disorder) can cause involuntary muscle contractions, leading to abnormal head positioning.

- Infections: Infections of the neck, such as meningitis or lymphadenitis, can cause pain and stiffness, resulting in torticollis.

- Trauma: Whiplash or other neck injuries can lead to muscle spasms and torticollis.

- Structural Abnormalities: Conditions like scoliosis or chest wall deformities (such as pectus excavatum) can contribute to muscle imbalances and postural issues, potentially leading to torticollis.

Complications of Torticollis
If left untreated, torticollis can lead to several complications:
- Chronic Pain: Persistent muscle strain can lead to chronic neck pain and discomfort.

- Sleep Disturbances: As you mentioned, pain and discomfort can interfere with sleep, leading to fatigue and decreased quality of life.

- Postural Issues: Over time, torticollis can lead to compensatory postural changes, affecting the alignment of the spine and potentially leading to further musculoskeletal issues.

- Jaw Misalignment: As you noted, a tilted head position can lead to misalignment of the jaw (malocclusion), which can cause additional pain and discomfort in the jaw and facial region.

Management and Treatment
1. Physical Therapy: Engaging in physical therapy can be beneficial. A physical therapist can provide exercises to strengthen weak muscles, stretch tight muscles, and improve overall neck mobility. Techniques such as manual therapy, ultrasound, and electrical stimulation may also be used.

2. Postural Training: Learning proper posture and ergonomics can help alleviate strain on the neck. This includes being mindful of head and neck positioning during daily activities.

3. Pain Management: Over-the-counter pain relievers, such as NSAIDs (e.g., ibuprofen), can help manage pain and inflammation. In some cases, muscle relaxants may be prescribed.

4. Botulinum Toxin Injections: For cases of cervical dystonia, botulinum toxin injections can help reduce muscle spasms and improve head positioning.

5. Surgery: In severe cases where conservative treatments fail, surgical options may be considered, particularly for congenital torticollis.

Conclusion
Given your symptoms of pain, stiffness, and postural imbalances, it is essential to seek a comprehensive evaluation from a healthcare professional, preferably a neurologist or a physical medicine and rehabilitation specialist. They can help determine the underlying cause of your torticollis and develop a tailored treatment plan. Addressing the issue early can prevent further complications and improve your quality of life. Additionally, maintaining a proactive approach to your physical health, including regular exercise and awareness of posture, can significantly contribute to your recovery and overall well-being.

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