Torticollis is a disorder of the neck muscles that causing head Becomes crooked. If it lasts in the long term, torticollis can cause pain and make it difficult for sufferers to carry out daily activities.
Torticollis is generally caused by congenital conditions or abnormalities during fetal formation. However, in some cases, torticollis can occur due to certain medical conditions experienced after birth.
Torticollis must be treated as soon as a person is diagnosed with this disease. Prompt treatment can increase the potential for successful healing and prevent long-term complications.
Causes of Torticollis
Torticollis occurs when the muscles sternocleidomastoid (SCM) on one side of the neck is shorter than the SCM muscle on the other side. This muscle extends from behind the ear to the collarbone. Most cases of torticollis have no known cause or are called idiopathic torticollis.
However, there are several things that are known to cause torticollis, including:
- Genetic disorders that are passed down from parents
- Lack of blood supply to muscles
- Disorders of the nervous system, muscles, or upper spine
- Infections of the soft tissue or connective tissue around the neck and ears
- Tuberculosis of the spine that occurs in the neck
- Pressure on one of the SCM muscles, which can result from an abnormal position of the fetus, such as a breech, or a forceps or vacuum assisted delivery
Symptoms of Torticollis
The main symptom of torticollis is a tilted head position. If present from birth, torticollis is often not seen in the first 1-2 months. Symptoms usually can only be seen when the baby is able to move his neck and head.
The following are some of the symptoms that can be noticed in babies:
- Tendency to suckle on only one breast
- Soft lump in neck muscles
- The head looks flat on one or both sides, due to frequent lying in a certain position (plagiocephaly)
- Babies have difficulty following their mother's movements or cry when they try to turn their heads
Generally, the symptoms of torticollis that have occurred since infancy will worsen and become more pronounced over time. In children, symptoms of torticollis can include:
- Head tilted to one side and chin slightly raised
- Head difficult to shake or nod
- Delays in the development of motor function
- Hearing and vision impairment
- Asymmetrical face shape
In adults, the physical signs of torticollis are not much different from those in children. However, because torticollis has been around for a long time, some additional symptoms may appear, such as:
- Stiff neck muscles
- Neck pain
- Head tremor
- One side of the shoulder looks higher
- Chronic tension headaches
When to go to the doctor
Immediately see a pediatrician if you notice any symptoms of torticollis in your baby. The earlier treatment is carried out, the better the results that can be obtained.
If you have torticollis, consult a doctor about the treatment that can be done, so that complaints due to torticollis do not interfere with your productivity.
Immediately consult a doctor if torticollis occurs suddenly, especially if it occurs after trauma or if it is accompanied by fever, difficulty swallowing, pain when swallowing, and breath sounds like snoring.
Diagnosis of Torticollis
The doctor will first ask questions about the patient's symptoms and complaints. In addition, the doctor will also ask the patient's medical history, including a history of neck injuries that may have been experienced.
After the question and answer session, the doctor will perform a physical examination, to determine the patient's ability to move the head. The doctor will also examine the condition of the neck and upper spine.
To confirm the diagnosis, the doctor will perform further tests, which include:
- Scans with ultrasound, CT scan, or MRI, to check for possible problems with the tissue structures in the head and neck
- Blood tests, to check if torticollis is related to another condition, such as an infection
- Electromyogram (EMG), to measure the electrical activity of the muscles and determine the part of the muscle that is affected
Treatment Torticollis
Torticollis should be treated as soon as possible to avoid serious complications. If your baby has torticollis, talk to your doctor about possible treatments. Your doctor can teach you how to train your baby to do stretch therapy independently, such as:
- Get used to the baby looking in the opposite direction from the direction he usually does. This aims to relax tense muscles, so that he is accustomed to looking in both directions.
- Teach and familiarize the baby to play by using his hands and feet. The goal is to strengthen the muscles in his arms and legs, so he is ready to learn to crawl.
- Lay the baby on your stomach for at least 15 minutes, 4 times a day. It aims to strengthen the baby's neck and back muscles, and prevent flat head syndrome.
It is important to remember, the above therapy needs to be accompanied by regular visits to the doctor. Generally, infants with torticollis show improvement 6 months after therapy. However, in some cases, the baby may need surgery to repair the neck muscles.
Adult torticollis patients are also advised to move their neck frequently to relax the neck muscles. But keep in mind, initially the patient will feel pain and need to rest for a few days. After the pain is gone, the patient is advised to return to stretching the neck so that the neck is not stiff.
In addition, the doctor will also suggest physical therapy, such as:
- Massage
- warm compress
- Physiotherapy
- Chiropractic therapy
- Use of neck brace
- Electrical therapy, such as transcutaneous electrical nerve stimulation (TENS)
If the methods above are not effective, the doctor will suggest the following treatment methods:
Administration of drugs
Drugs that can be given by doctors in adult torticollis patients include:
- Pain relievers, eg codeine
- muscle relaxants, such as baclofen and diazepam
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as diclofenac and naproxen
- Botulinum toxin (Botox) injections, which must be repeated every few months
The use of drugs needs to be accompanied by regular control. In addition to knowing the effectiveness of treatment, routine controls are also carried out to check the development of torticollis.
Operation
Surgery or surgery is performed on patients with torticollis whose complaints do not improve with medication. A number of surgical procedures that can be performed are:
- Selective denervation, which is the act of cutting specific nerves that control muscles sternocleidomastoid on the side that has the abnormality, so that the muscle can shrink and weaken
- Sternocleidomastoid release, namely surgery to lengthen the neck muscles that have abnormalities
- Dorsal cord stimulation, namely the installation of electrodes that send weak electric currents to the spinal cord, to relieve pain
- Deep brain stimulation, namely the installation of electrode implants into certain areas of the brain that regulate muscle tone
Complications of Torticollis
Torticollis caused by a minor injury is generally temporary and easy to treat. However, in severe cases, torticollis must be treated immediately to prevent serious complications.
Some of the complications that may occur in babies with torticollis are:
- Eating disorders
- Balance disorders
- Slow learning to sit or walk
- Can only roll to one side
- Facial defects or deformities
- flat head syndrome
Meanwhile, complications that may be experienced by adult torticollis patients include:
- Chronic pain
- Swelling of neck muscles
- Difficulty performing routine activities
- Unable to drive a vehicle
- Disorders of the nervous system
- Depression
Torticollis Prevention
Torticollis cannot be prevented. However, you can prevent this disease from getting worse, by taking the first treatment as soon as possible. Handling that can be done is with independent stretching therapy, as described above.
To achieve significant results, independent stretching therapy should be done since 3 months after the baby is born. Improvement is generally seen after 6 months of therapy, but in certain cases improvement can take years.