Torticollis
| Classification according to ICD-10 | |
|---|---|
| M43.6 | Torticollis |
| Q68.0 | Congenital deformities of the sternocleidomastoid muscle torticollis congenitus (muscularis) |
| P15.2 | Injury to the sternocleidomastoid muscle from birth injury |
| F45.8 | Other somatoform disorders Psychogenic torticollis |
| G24.3 | Torticollis spasticus |
| ICD-10 online (WHO version 2019) | |
With torticollis (also torticollis ) or torticollis ( latin ; of tortus "rotated" "curved" and collum "neck") refers to a congenital or acquired Skew- or malposition of the neck . The causes for this are different and can, for example, be an expression of a neurological disease (cervical dystonia ), in which there is uncontrolled movements (torticollis spasticus or spasmodicus ) or poor posture of the head. In the case of painful diseases in the field of ear, nose and throat medicine , a symptomatic torticollis can occur as a relieving posture . In ophthalmology , an "ocular torticollis" is known as a compensation mechanism for eye muscle paralysis and nystagmus . Rheumatic forms are also known.
to form
In medicine, different types are distinguished, which can also occur in combination:
- rotating: rotatory torticollis
- inclined towards the shoulder: laterocollis
- Bent forward on the chest: anterocollis
- overextended backwards: retro collis
The bad posture can be accompanied by rhythmic and sometimes violent movements. It is not uncommon for the axis between the head and body to be shifted, and shoulder elevation can also occur.
causes
A distinction is made between congenital muscular, skeletal (e.g. Klippel-Feil syndrome ), rheumatic , ocular , somatoform and neurological causes. In the latter, the disease process takes place in the brain in the extrapyramidal system and here especially in the basal ganglia . Causes of the torticollis can be:
- Damage to certain brain regions caused by strokes , tumors , brain injuries or inflammations, vascular malformations, consequences of accidents ( whiplash )
- Metabolic diseases
- Taking medications that act on the basal ganglia
- Birth trauma due to bleeding into the sternocleidomastoid muscle
- Posterior fossa tumor
- Calcification of the intervertebral discs
- injury-related ( torticollis traumaticus )
- As a pain-related posture for inflammation in the ear, nose and throat area ( Grisel syndrome ), e.g. B. with peritonsillar abscess , acute cervical lymph node inflammation, Bezold abscess
Usually no damage can be determined ( idiopathic disease).
Congenital muscular torticollis
The clinical picture of the congenital (congenital) torticollis, also known as "torticollis muscularis congenitus", is caused by a shortening of the sternocleidomastoid muscle . This form of torticollis must always be treated early with children's physiotherapy. Appropriate measures consist of stretching exercises, specific positioning and handling instructions for the parents. In the case of very pronounced forms and / or lack of improvement, child orthopedic treatment must be considered.
Torticollis ocularis
The symptom of a head tilt is also used in ophthalmology (ocular torticollis or head posture) to compensate for an imbalance of the eye muscles . It can take the form of turning, tilting, raising or lowering the head, or a combination of all of the above.
The most common cause of an obsessive head posture is paralysis of one or more external eye muscles . This results in restrictions in the ability of the eye to move, as well as squinting with double vision . To avoid this double vision, the patient usually turns his head in the direction of the affected muscle in order to leave his area of action. The view is thus directed in a direction in which the muscle is not or only minimally active and therefore ideally no more double vision. It also happens that people with eye muscle imbalance adopt a forced head posture in order to enlarge the distance between the double images so much that their occurrence is no longer disturbing. In this case, the head is directed against the direction of pull and restriction of movement of the affected muscle.
Another cause of forced head posture is what is known as nystagmus (eye tremors). In some cases, the head posture can achieve relative or even absolute calmness of the eye tremors and thus an improvement in visual acuity.
The exact analysis and measurement of all components of an obsessive-head posture are an important diagnostic aspect with regard to a therapeutic approach in the field of strabology and neuro-ophthalmology .
treatment
A generally binding established therapy does not exist due to the different genesis. Rehabilitation measures are often necessary. Treatment methods for cervical dystonia can include:
- Injection of botulinum toxin into the affected muscles
- Physiotherapy , possibly before the age of 1
- Taking medication (in acute cases e.g. Biperiden )
- operative interventions, e.g. B. Denervation (surgical separation of the nerves from the affected muscle) or myotomy (surgical separation of muscles) or tenotomy (separation of the tendons, already used by Ferdinand Sauerbruch )
- In the case of an ocular torticollis, the treatment of the underlying disease is in the foreground, for example by means of eye muscle surgery.
course
Depending on the cause, in addition to spontaneous healing , phases of improvement and deterioration can often occur over the course of a day.
Even after surgical treatment, further physiotherapeutic treatment and regular follow-up examinations must be carried out in order to detect a recurrence in good time. If left untreated, certain forms of torticollis can lead to long-term effects.
Veterinary medicine
Forms of torticollis are also known in the veterinary field , for example in rabbits.
Individual evidence
- ↑ a b Herbert Kaufmann and others: Strabismus. 4th, fundamentally revised and expanded edition. Georg Thieme Verlag, Stuttgart / New York 2012, ISBN 978-3-13-129724-2 .
- ↑ German Pension Insurance: GUIDELINES ON THE NEED FOR REHABILITATION FOR SERVICES FOR PARTICIPATION IN WORKING LIFE
- ^ Ferdinand Sauerbruch, Hans Rudolf Berndorff : That was my life. Kindler & Schiermeyer, Bad Wörishofen 1951; cited: Licensed edition for Bertelsmann Lesering, Gütersloh 1956, p. 328 f.
- ↑ E. Peterson, FJ Erbguth: Torticollis spasmodicus: Long-term results of physiotherapy, botulinum toxin injections and surgical treatments . Springer Verlag, 2004, ISBN 3-540-67448-9 .
- ↑ Jörg Zinke: Holistic treatment of rabbits and guinea pigs . Georg Thieme Verlag, 2004, ISBN 3-8304-9090-9 .
swell
- Georges L. Kaiser: Symptoms and Signs in Pediatric Surgery . Springer-Verlag, Berlin / Heidelberg 2012, ISBN 978-3-642-31160-4 .
- C. Happle, M. Wetzke, EJ Hermann, JK Krauss, H. Hartmann, T. Lücke: "Cases against KiSS": A diagnostic algorithm of early childhood torticollis. In: Clinical Pediatrics. 2009; 221 (7), pp. 430-435. doi: 10.1055 / s-0029-1243162
