A Wry Neck (aka torticollis or stiff neck) is a condition resulting from spasm and contracture (shortening) of neck muscles, mainly those supplied by the spinal accessory nerve (sternocleidomastoid and trapezius). A person with wry neck will typically present with the head drawn to one side and usually rotated so that the chin points to the other side (ie. flexion, rotation and lateral flexion). Torticollis can be congenital or acquired. Congenital torticollis develops in the infant, whereas acquired torticollis can occur in all ages, whether infants, children or adults.

Congenital Torticollis

This condition is caused by birth trauma or poor positioning inside the womb, resulting in injury to the sternocleidomastoid muscle. A mass inside the muscle is sometimes evident as early as a few weeks old, and gradually disappears. The presence of congenital torticollis is often associated with incidences of plagiocephaly.

Congenital torticollis in most cases respond well to physiotherapy, which includes exercises for stretching, strengthening, and other activities to encourage symmetrical tilting and rotating of the head/neck.

Acute Wry Neck (Acquired Torticollis)

Causes

The acute wry neck is fairly common and can be extremely painful. A wry neck usually develops after:

  • Spasm in the occipitalis, sternocleidomastoid, trapezius, splenius cervicis, or levator scapulae muscles can be the primary cause of the torticollis
  • Awkward posture during sleep resulting in wry neck upon waking
  • Minor turning of the head
  • Vigorous and sudden movement or injury
  • Other activities that involve sustained awkward positioning, slouching, poor posture during lifting
  • Excessive or repetitive neck movement
  • Other causes include slipped facet joint, herniated disc, or viral/bacterial infection

Symptoms

  • Pain is typically one-sided and may be described as sharp
  • Pain located in the neck muscles or referred down the spine, from the occiput to between the shoulder blades
  • Inability to turn the head to the painful side
  • Maybe a postural deformity (head tilted away from the painful side) due to pain and spasm

1. Apophyseal Wry Neck

  • Usually occurs in younger people from adolescence to ~ 30yrs
  • Associated with sudden movements resulting in sharp pain
  • Postural deformity of flexion, rotation and lateral flexion away from the damaged joint
  • No associated radiation of pain

2. Discogenic Wry Neck

  • Can occur all ages, but generally occurs in older people
  • Gradual onset and typically occurs upon waking from a long sleep in an awkward posture
  • Pain usually felt in the lower cervical and upper thoracic region
  • May be some radiation of pain

Physical Examination

Observation: Head position, symmetry

Palpation: Muscle spasm, point tenderness, masses, infection (heat)

Active/Passive Range of Motion (ROM): Limited cervical ROM and dystonia of strenocleidomastoid and paracervical muscles

Neurological: Check for any signs of nerve root compression/irritation/compromise

Treatment

  • Reduce muscle spasm with hot pack (heat) or ice (can alternate heat with ice massage), electrophysical agents
  • Manual traction in the line of the deformity (for apophyseal wry neck)
  • Manual traction away from the pain (for discogenic wry neck)
  • Mobilisation of the joint (only for apophyseal, not for discogenic)
  • Trigger point release
  • Soft tissue massage
  • Active range of motion exercises
  • Stretching exercises
  • Exercises to improve flexibility, strength, posture and core stability
  • Ergonomic advice
  • Postural care and correction
  • NSAIDS (for pain control if required)

Differential Diagnosis

  • Infection (eg. fever, toxic appearance, lymphadenopathy, tonsillar swelling, trismus, pharyngitis, dysphagia)
  • Pharyngotonsillitis in young children (this can soften the atlantoaxial ligament and allow subluxation)
  • Dystonic drug reaction (phenothiazines, butyrophenones, haloperidol)

Summary

Most wry necks are short term and respond well to physiotherapy treatments. For more information or if you have comments/questions, please contact us HERE.