Torticollis in Adults

You need your neck muscles working properly in order to be able to move it in all its directions. The neck muscles are connected to the bones through tendon insertions. If you overexert your neck or injure it, you can do damage to your muscles and this can result in a decreased range of motion about the neck. This is known as torticollis. Torticollis can affect people of all ages. You can even get torticollis in adults.

What Is Torticollis in Adults?

Torticollis happens when the neck is tilted to one side. On one side of the neck, the muscles are really tight. On the other side, they are really weak. The main muscle affected is the sternocleidomastoid muscle that runs along the back and side of the neck. There are many types of torticollis. When it occurs in adults, the condition is called spasmodic torticollis. Spasmodic torticollis and cervical dystonia (which is a neurological problem believed to stem from the basal ganglia in the brain) can be caused by the following problems:

  • ŸTrauma to the neck or spine. If you traumatize your neck, you can get torticollis. This can mean an injury to the neck or spine muscles, leading to spasm of the muscles so that the neck twists to one side.
  • ŸInfections of the neck or head. An infection inside the neck or head can lead to torticollis in adults. The infections settle into the lymph nodes of the neck, causing the overlying muscles to become contractile. You can also get torticollis if you have an abscess of the upper airway or throat. These can be life-threatening conditions. Other possible infections include ear infections, mastoiditis, sinus infections, tooth infections, scalp infections, and jaw infections.
  • ŸMedications. There are medications that can cause torticollis that happens to adults. These include cocaine, amphetamines, and ketamine. Even the neuroleptic medications like Compazine, Haldol, and Thorazine can result in torticollis or acute dystonia of the neck and head. When this happens, there is the sudden onset of involuntary contractions of the neck, back, or face.
  • ŸRare causes. In rare circumstances, torticollis that happens in adults can be due to arthritis, scar tissue, or tumors of the neck. Vascular problems may also result in torticollis.

Common risk factors for torticollis to adults includes having a family history of torticollis, certain birth defects involving the cervical spine, trauma to the neck, and a predisposition to muscular spasm as a result of taking certain medications.

What Are the Symptoms of Torticollis in Adults?

Initially, the symptoms of torticollis can be very minimal. Some people notice an invisible tremor of their head for a couple of months. The head may then turn or be pulled to one side. The head can also be stuck in one position. The symptoms can be worsened by stress or excessive walking. Other symptoms you might notice include neck pain, muscle hypertrophy, tremor, and dysarthria. Studies have reported 75 percent incidence of neck pain and 33-44 percent of people will notice a head tremor.

The head can be jerked into many different directions when you have spasmodic torticollis. The directions the head can twist in include the following:

  • The ear can be pulled toward the shoulder
  • The chin can be pulled toward the shoulder
  • The chin can be pointed straight up in a forward direction
  • The chin can be pointed straight down in a forward direction

How to Treat Torticollis in Adults

1.   Medications

Certain medications can relieve torticollis. These include medications used to treat the tremor associated with having Parkinson's disease. These medications have other side effects, such as memory difficulties, constipation, blurred vision, decreased urinary stream, or dry mouth. Muscle relaxants can also be used to relieve the tilting of the head, but they can also cause poor balance, cognitive difficulties, and sedation. Some of these include diazepam, lorazepam, clonazepam, and baclofen. Certain pain medications can help relieve the symptoms as well. You can use over the counter medications for pain or even prescription painkillers.

2.   Botulinum Toxin

This is a medication that can paralyze the muscles. They are often used for wrinkling of the face but can be injected into the neck muscles to relieve muscle spasm. The most commonly used botulinum toxin is called Botox but Xeomin, Dysport, and Myobloc. This helps most people with torticollis, but it lasts only about 3-4 months before you need another injection.

3.   Therapy

Certain physical therapy exercises can help torticollis. These include using a neck brace for comfort, doing exercises that maximize flexibility and neck muscle strength, and anything that can help reduce your stress levels.

You can watch the video below to learn some exercises.

4.   Procedures

If the less invasive therapies don't work, surgery may be recommended. These include procedure that cuts the nerves or muscles in the neck that cause the abnormal posture. The procedure is called selective denervation and it isn't used very often. Deep brain stimulation can also be done. This involves guiding a thin wire into the brain via a small hole within the skull. The wire is put into the part of the brain controlling movement. Then electrical impulses are sent via the wire to interrupt the signals in the brain that cause the head to twist. This is reserved for serious cases of torticollis.

5.   Home Care

While torticollis cannot be cured, there are some things you can do at home to take care of it. These include lessening your stress level because stress will make the torticollis worse. Heat can also be applied to the neck to lessen the spasm of the neck muscles. You can use heating packs or a heating pad. There are also some tricks you can do. For instance, touching the opposite side of the face or the back of the head can temporarily relieve the spasms. A majority of the time, the acute torticollis goes away within a few weeks. A few people will not get immediate relief and will suffer from neck pain and torticollis for many years. 

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