Wryneck Torticollis - Medical Treatments and Alternative Therapies
Wryneck and torticollis are characterized by painful spasms in the neck. A wryneck usually occurs suddenly and is self limited, often vanishing mysteriously. In contrast, torticollis comes on gradually; at first it is intermittent, but it keeps worsening until affected muscles are chronically contracted and the neck posture remains abnormal more or less permanently. Wryneck and torticollis are relatively common, affecting about 1 in 10,000 people, with women slightly outnumbering men. What causes the muscle spasms is often unclear. In some acute cases, entrapment of a nerve arising from the upper spinal cord is responsible. Infection, inflammation, dislocation of a joint in the neck, a thyroid disorder, and a tumor are other possible causes. Heredity is also a possible factor. In congenital torticollis, a baby is born with an injured or malformed neck muscle. Many patients have other involuntary muscle tics and spasms, or spasmodic dystonia, as well. Doctors are frequently unable to identify any single reason for wryneck or torticollis. In the past, cases were often attributed to hysteria and treated as a mental disorder. Physicians now agree that although torticollis can lead to emotional problems, those problems are rarely, if ever, the underlying cause of the affliction.
Diagnostic Studies And Procedures
Newborns should be carefully examined for signs of muscular asymmetry affecting the neck. Adults will be questioned about past nerve and muscle disorders, and recent accidents involving the head and neck. Tests will include a neurological examination, X-rays, CT scans, or MRI, and possibly electromyography, which are studies of the muscles\' electrical impulses.
Medical Treatments
Most patients benefit from a combination of medical and alternative therapies. Regardless of treatment, 10 to 20 percent recover spontaneously within five years. The outlook, however, is best for patients whose problem stems from an identifiable orthopedic disorder.
Drug Therapy
Prescribed drugs usually include such painkillers as aspirin or stronger nonsteroidal anti inflammatory agents; anticholinergic drugs such as trihexyphenidyl to block certain nerve impulses; and muscle relaxants, such as diazepam (Valium). In some cases, haloperidol or perphenazine (Etrafon or Triavil) are prescribed, but side effects such as lethargy and movement disorders limit their use. Studies indicate that injections of botulinum toxin type A into neck muscles reduce painful spasms and normalize head positions for up to three months in most patients. However, this treatment has not yet been approved by the FDA for neck problems.
Surgery
When other approaches have been unsuccessful, neurosl1rgery to sever some of the nerves that control the neck muscles may help.
Alternative Therapies
A combination of physical therapy and massage sometimes provides temporary relief, and if started in the first year of life, can cure congenital torticollis. The daily regimen includes stretching the shortened neck muscle that holds the head at an abnormal angle. Other alternative therapies include:
Acupuncture and Acupressure
Six sessions with a qualified acupuncturist may provide relief and halt the muscle spasms. Applying pressure to the jaw may give temporary relief.
Biofeedback Training
This technique, which helps a patient control and relax neck muscles, is now a standard treatment.
Chiropractic
Many chiropractors specialize in the treatment of neck pain, including wryneck, using manipulation and electrical stimulation.
Hydrotherapy. Whirlpool baths, alternating hot and cold needle showers, and underwater massage are used by some physical therapists to alleviate muscle spasms and neck pain.
Massage Therapies
Traditional massage, perhaps combined with physical therapy, can be helpful. Others find the more vigorous massage of rolfing or shiatsu beneficial.
Meditation
People who have tension induced wryneck might benefit from meditation and breathing exercises.
Self Treatment
Application of heat can sometimes ease simple wryneck. A battery operated vibrating neck massager that can be worn like a scarf while you read, work at a desk, or do chores may also help. If you work at a computer or use the telephone often, take frequent breaks. Change positions, shrug your shoulders, and gently move your head from side to side. Don\'t cradle the phone between shoulder and neck; instead, try a speakerphone or headphone. Maintain good posture, keep your shoulders down, and avoid sudden head movements. Try to sleep on your back, using a rolled neck pillow. If you suffer chronic neck pain, use a special pillow that provides hot and cold therapy. Sold at medical supply stores, these have a gel pack that can be cooled in the freezer or heated in the microwave and then inserted into a sleeve that fits under the neck. On a long car or plane trip, rest your head on a traveler\'s neck pillow. If a spasm develops, rub it with an ice cube wrapped in a plastic bag using a circular motion. If this doesn\'t help, take a hot shower. A pulsating shower massage on the tensed muscle may relax it.
Other Causes of Neck Spasms
Whiplash and other neck injuries can cause muscle spasms and pain. In some cases, tardive dyskinesia, a movement disorder caused by potent antipsychotic drugs, affects the neck.
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