Acute wry neck or torticollis can develop suddenly as severe stiffness and pain in the neck, with a spasm in the neck muscles. Torticollis is usually associated with newborn babies where they have been in a position with their head tilted for a prolonged period of time, either in the birth canal during labour and delivery or during breastfeeding or sleeping. However, we are going to only consider adult torticollis in this blog, also known as acute wry neck.
In adults wry neck originates in the cervical spine, either from the facet joint (present on side of spine) or the intervertebral disc present between the vertebra. The common features of both are inflammation and muscle spasm
Facet joints are present on either side of the spine and they allow for smooth gliding movements between the adjacent vertebra. These joints can get stiff from injuries or degenerative changes. However most commonly, they can get locked from being taken to their extreme range of motion.
5 features of wry neck due to locked facet joint:
- Onset of pain is sudden and severe.
- Most patients will report having slept in the wrong position at night and woken up in the morning with the neck tilted to one side.
- Neck is tilted towards the painful side due to the mechanical block of the locked facet.
- Sudden sharp shooting pain in the centre or side of the neck when trying to bring the head back to neutral. Pain may radiate up into the head.
- Inability to move the neck in any direction without the sharp pain. This loss of range of movement is a distinguishing feature when compared to discogenic wry neck.
A similar condition can also be seen in the lumbar spine, where patients report getting ‘stuck’ into an exercise or yoga position and unable to come back to neutral. This also has the same features due to the locked lumbar facet, as described above but the symptoms are seen in the lumbar area, with stiffness in the low back and buttock.
Wry neck can also occur in the cervical spine due to the intervertebral disc.
5 features of discogenic wry neck:
- Onset is gradual and the pain is dull and diffuse in nature.
- Neck is tilted away from the affected side.
- Movements are not as limited as a locked facet.
- Tingling numbness or pins and needles may radiate into the arms, shoulder, shoulder blades or the upper chest.
- Main feature is stiffness of the neck due to muscle spasm rather than loss of range of motion.
Discogenic wry neck takes four to six weeks to treat while locked facets usually resolve in seven to ten days. However discogenic wry necks are not as common as wry neck due to locked facets.
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