Objectives:

2. Objectives: . To know what's the meaning of torticollis(wry neck) and what are the causes. . To fully understand the clinical signs and symptoms of torticollis . To know what type of investigations can be done to confirm diagnosis of torticollis . To know how to treat torticollis .Understandig the prognosis & complications possible in wry neck . How to prevent torticollis

3. What is it? -Also known as Wryneck -Head and chin are tilted at opposite angles, causing head to twist -Asymmetrical Appearance Effected muscle: sternocleidomastoid

5. What is it? Can exist before or at birth Congenital Muscular Torticollis Can occur during childhood up through adult age Acquired/Noncongenital Muscular Torticollis

7. Prevalence Less than .4% of newborns Torticollis does not prefer one side of head or the other In adults, noncongenital muscular torticollis has an average onset of 40 years old Females twice as likely afflicted than males

8. Etiology? Not well understood Almost 80 entities have been reported to cause torticollis Common causes: Developmental disorders affecting sternocleidomastoid muscle Imbalance in function of cervical muscles Other abnormalities in skull/cervical area

9. Other etiology.. • Genetic defect • Infants position during pregnancy or delivery • Tumors in head or neck • Arthritis of neck • Pseudotumors in infants • Certain medications • Genes

10. Symptoms& signs

11. Limited range of motion of the head • Headache • Head tremor • Neck pain • Shoulder that is higher on one side of the body • Stiffness of the neck muscles • Swelling of the neck muscles (possibly present at birth)

14. Investigations

15. Tests or procedures may be done to rule out possible causes of head and neck pain. 1-A physical examination will show: • Head tilts toward the affected side while the chin points to the opposite side • Shortening of the neck muscles • The entire head pulls and turns to one side (in more severe cases)

16. 2-Tests that may be done include: • CT scan of the neck • Electromyogram (EMG) to see which muscles are most affected • MRI of the brain http://www.youtube.com/watch?v=qJjKEvSmeEI

18. Treatment of Torticollis

19. - Torticollis is caused by damage to the nervous system, spine, or muscles. - Treating torticollis that is present at birth involves stretching the shortened neck muscle. - Passive stretching and positioning are used in infants and small children. - These treatments are often successful, especially if they are started within 3 months of birth.

20. These treatments can include : - Medications include nonsteroidal anti-inflammatory drugs (NSAIDs), benzodiazepines and other muscle relaxants, anticholinergics, and local intramuscular injections of botulinum toxin or phenol. - Injecting botulinum toxin can temporarily relieve torticollis, but repeat injections are usually needed every 3 months.

21. - Physical therapy includes stretching exercises, massage, local heat, analgesics, sensory biofeedback, and transcutaneous electrical nerve stimulation (TENS). - Neck braces may help with muscle spasms.

22. - In many individuals, torticollis will resolve by itself in several days to a few weeks. - In a few individuals, continuing problems with the neck may continue for months even years. - If these neck muscle spasms persist the doctor may refer the individual to a neurologist or surgeon.

23. -Surgeryto correct the neck muscle may be done in the preschool years, if other treatment methods fail. Surgical therapy may consist of the following: - Unipolar sternocleidomastoid release. - Bipolar sternocleidomastoid release. - Selective denervation. - Dorsal cord stimulation.

24. -Surgery of the spine might be needed when the torticollis is due to dislocated vertebrae. -In some cases, surgery involves destroying some of the nerves in the neck muscles, or brain stimulation.

25. Prognosis of Torticollis

26. - The condition may be easier to correct in infants and children. - If the condition becomes chronic, numbness and tingling may develop as nerve roots become compressed in the neck. - The muscle itself may become large (hypertrophic) due to constant stimulation and exercise. - Botulinum toxin injections often provide substantial relief.

27. - In most individuals, torticollis progresses gradually over a period of months to years. - Complete remission sometimes occurs. - Remission rates of 12% to 21% have been reported, especially in younger individuals during the first 5 years after onset of the disease (“Spasmodic Torticollis/Cervical Dystonia”). - The majority of remissions are only temporary. - In many cases, torticollis may persist for life and can result in restricted movement and postural deformity.

28. - After surgery, the mobility of the neck may not return completely to normal, and some individuals may experience numbness on the back of the head that extends to the top.

29. Possible Complications Complications may include: •Muscle swelling due to constant tension. •Nervous system symptoms due to pressure on nerve roots.

30. Prevention While there is no known way to prevent this condition, early treatment may prevent it from getting worse.

31. Refrences • http://www.nlm.nih.gov/medlineplus/ency/article/000749.htm • http://chealth.canoe.ca/condition_info_details.asp?disease_id=128 • http://www.google.com.sa/search?hl=ar&safe=active&biw=1333&bih=668&site=imghp&tbm=isch&sa=1&q=torticollis+xrays&oq=torticollis+xrays&gs_l=img.3...491891.494765.0.495202.5.5.0.0.0.0.333.1214.2-2j2.4.0...0.0...1c.1.9oH6BsYnQ9g

32. http://www.nlm.nih.gov/medlineplus/ency/article/000749.htm http://www.iamunwell.com/Diseases-Alphabet-T/torticollis.html http://emedicine.medscape.com/article/1152543-treatment http://www.mdguidelines.com/torticollis/prognosis