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Torticollis
From WikEM
Contents
Background
- Common term for various conditions of head and neck dystonia
- spasmodic torticollis is an abnormal contraction of the muscle in one side of the neck.
- Idiopathic (80-90%)
Clinical Features
- Painful neck with inability to fully range laterally
Differential Diagnosis
Neck pain
- Musculoskeletal
- Torticollis
- Cervical spondylosis
- Cervical stenosis
- Cancer
- Cervical spine fracture and/or dislocation
- Epidural abscess
- Vertebral osteomyelitis
- Transverse myelitis
- Temporal arteritis
- Epidural hematoma (anticoagulation, hemophilia)
- Cervical disk herniation
- Blunt neck trauma
- Anterior horn disease
- C1 and C2 fractures
- Radiculopathy
Evaluation
- Clinical Diagnosis
- Consider cervical X-ray to rule out fracture or dislocation (unlikely to be necessary if no midline tenderness or history of trauma)
Management
Acute
Pain control and muscle relaxation
- Opioid (e.g. 1-2 tabs of Norco) +/- benzodiazepine (e.g. diazepam) PO
Chronic
- Benztropine
- Muscle relaxants
- Botulinum toxin
- Physical Therapy
Disposition
- Normally outpatient
