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Chapter 57: Torticollis in a Child

Hugh G. Watts; Sharon K. DeMuth

Description of the Symptom

Torticollis (also commonly known as "wry neck") is a symptom or physical sign where the neck is turned, and may or may not be tilted. The term is derived from the Latin tortus ("twisted") and collum ("neck"). This symptom has many causes. This chapter describes possible causes of torticollis in a child.

Special Concerns

  • Torticollis of sudden onset (few days)

  • Any torticollis where the head is both tilted and rotated to the same side

  • Any post-traumatic torticollis

  • Any neurological signs suggesting an intracranial tumor or space-occupying tumor of the spinal cord

CHAPTER PREVIEW: Conditions That May Lead to Torticollis in a Child
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CHAPTER PREVIEW: Conditions That May Lead to Torticollis in a Child
T  Trauma
COMMON
Not applicable
UNCOMMON

Muscle strain 1104

Rotary subluxation of C1–C2 1105
RARE

Cervical spine fractures and dislocations 1103

Clavicle fracture with or without brachial plexus injury 1103
I  Inflammation
COMMON

Aseptic

Spastic torticollis 1106

Septic

Tonsillitis/adenitis 1107
UNCOMMON

Aseptic

Not applicable

Septic

Pharyngeal abscess 1105
RARE

Aseptic

Juvenile rheumatoid arthritis 1104

Septic

Brucellosis 1103

Systemic fungal infection (such as actinomycosis, blastomycosis, coccidioidomycosis, and histoplasmosis) 1106

Tuberculosis of the cervical spine 1107
M  Metabolic
COMMON
Not applicable
UNCOMMON
Drug intoxication 1104
RARE
Not applicable
Va  Vascular
COMMON
Not applicable
UNCOMMON
Not applicable
RARE
Not applicable
De  Degenerative
COMMON
Not applicable
UNCOMMON
Not applicable
RARE
Not applicable
Tu  Tumor
COMMON

Malignant Primary, such as:

• Posterior fossa tumor 1105

Malignant Metastatic:

Not applicable

Benign:

Not applicable
UNCOMMON

Malignant Primary, such as:

• Posterior fossa tumor 1105

Malignant Metastatic:

Not applicable

Benign:

Not applicable
RARE

Malignant Primary, such as:

• Chordomas 1103

Malignant Metastatic, such as:

• Spinal cord tumors 1106

Benign, such as:

  • Syringomyelia 1106

  • Thyroglossal duct cyst 1107
Co  Congenital
COMMON
Congenital muscular torticollis (infantile torticollis, developmental muscular torticollis) 1103
UNCOMMON

Multiple congenital cervical spine anomalies (Klippel-Feil disorder) 1104

Sprengel's deformity 1106
RARE
Arnold-Chiari malformation (Chiari malformation) 1103
Ne  Neurogenic/Psychogenic
COMMON
Not applicable
UNCOMMON
Psychogenic 1105
RARE

Extraocular muscle paresis 1104

Neurological dyskinesias:

  • Benign paroxysmal torticollis of infancy 1105

  • Dystonia musculorum deformans 1105

  • Sandifer's syndrome 1105

Note: These are estimates of relative incidence because few data are available for the less common conditions.

Common Ages at Which Torticollis Presents in a Child
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Common Ages at Which Torticollis Presents in a Child
APPROXIMATE AGE CONDITION
Birth to 3 Years

Benign paroxysmal torticollis of infancy

Clavicle fracture with or without brachial plexus injury

Congenital muscular torticollis

Neurological dyskinesias
Preschool (3–5 Years)

Chordomas

Extraocular muscle paresis

Multiple congenital cervical spine anomalies (Klippel-Feil disorder)

Pharyngeal abscess

Posterior fossa tumor

Rotary subluxation of C1-C2

Spinal cord tumors

Sprengel's deformity

Syringomyelia

Tonsillitis/adenitis
Elementary School (6–11 Years)

Juvenile rheumatoid arthritis

Muscle strain

Neurological dyskinesias:

  • Dystonia musculorum deformans

  • Sandifer's syndrome

Pharyngeal abscess

Psychogenic

Rotary subluxation of C1-C2

Tonsillitis/adenitis

Tumors:

  • Chordomas

  • Posterior ...

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