Medical News Today: What is wryneck and how is it treated?

Wryneck occurs when the neck muscles twist beyond their usual capacity, causing the head to tilt. The condition is also known as torticollis or loxia.

Wryneck may develop over time. It can also occur after an injury to the area, or because of a reaction to medication.

A person with wryneck may find it uncomfortable or painful to put their head up straight or bend their neck to the unaffected side.

Wryneck in infants is common, with some sources reporting that it affects 3 in every 100 babies. In most infants, the condition is easily treatable.

Benign paroxysmal torticollis of infancy (BPTI) is a much rarer medical disorder in infants where the baby experiences recurrent episodes of the head tilting to one side.

In this article, we take a look at the causes behind wryneck, along with the possible treatment options for this condition.

Causes

Woman holding her neck in pain due to wry neck
An injury or infection can cause wryneck.

In adults, there are several reasons why wryneck may develop, though doctors are often unable to specify a reason.

Some of the common causes include:

  • injury to the neck or spine, causing the muscles to spasm
  • infection of the head or neck, where inflammation causes the muscles to contract
  • abscesses in the throat or upper airway
  • infections of other parts of the body, such as ears, sinuses, jaw, teeth, or scalp

Less common causes of wryneck include:

  • scar tissue
  • arthritis of the cervical spine
  • vascular abnormalities
  • drug misuse that causes a lack of muscle control
  • use of certain medication
  • tumors

Wryneck in children

Children, infants, and newborns usually develop wryneck because of congenital muscular torticollis (CMT), meaning they are born with the condition.

CMT develops when a muscle on one side of the neck called the sternocleidomastoid muscle is too short.

Other causes of wryneck in children include:

  • trauma during birth
  • flat head syndrome, where an infant keeps their head in the same position whenever they sleep
  • inherited diseases that cause problems with the muscles and nervous system


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Types

There are several different types of wryneck. These include:

Temporary torticollis

Temporary torticollis will usually only affect a person for 1–2 days before disappearing. People with temporary torticollis may need to rest while keeping their neck as still as possible. They may not require any specific medical treatment, however.

Temporary torticollis can occur if the lymph nodes become inflamed after an infection or cold, or if a person has a neck injury that makes the joints between the neck bones swell.

Fixed torticollis

Fixed torticollis occurs because of an underlying problem with a person’s muscles or bone structure. It can also develop if a tumor is growing in the spinal cord, putting pressure on nerves in the area.

In children, fixed torticollis may cause their features to look unbalanced or their face to have a flattened appearance. Children may also experience a delay in their ability to use their facial muscles correctly.

Muscular torticollis

Muscular torticollis is the most common form of fixed torticollis. It happens when the muscles on one side of the neck are particularly tight, or when scar tissue affects mobility.

During pregnancy, muscular torticollis can develop in the fetus, if it moves into an unusual position in the womb, or the fetus does not have enough room.

Klippel-Feil syndrome

Klippel-Feil syndrome is a congenital condition. It develops when the bones in the neck do not grow correctly, and the neck becomes twisted.

People with Klippel-Feil syndrome may not be able to hear well if the bones in their ears are also affected.

Cervical dystonia

Cervical dystonia, also known as spasmodic torticollis, is a rarer form of the condition than other types. Cervical dystonia causes the neck muscles to spasm.

People with cervical dystonia experience painful episodes where the neck muscles contract and the head twists to one side, forward, or backward.

Symptoms

quadratus lumborum pain lady with back pain sitting at a desk
People with wryneck may also experience back pain.

Symptoms of wryneck vary from person-to-person. The most apparent sign of the condition is the neck twisting or tilting to one side.

People with wryneck may also experience:

  • painful, tense neck muscles
  • neck cramps or burning sensations in the neck
  • an unwillingness to turn or bend their head and neck to the opposite side
  • their eyes looking up without control
  • their tongue sticking out without control
  • jerky muscle spasms and head and neck movements
  • back pain
  • headaches

In infants, the symptoms of wryneck include:

  • tilting of the head to one side
  • flattening on one side of the head behind the ear
  • limited movement in the head and neck
  • features of the face appearing asymmetrical
  • a small, soft lump in the neck
  • breastfed babies favoring one breast over the other
  • musculoskeletal problems, such as hip dysplasia

In cases of torticollis that develop after birth, a baby may appear tired, irritable, and may vomit during episodes of head tilting.


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Diagnosis

A doctor will diagnose wryneck with a physical examination and by asking questions about family history. They may also inquire about any current medications the person is taking.

The doctor may request X-rays of the neck to work out whether the problem is due to a bone fracture or dislocation.

A CT scan may be necessary to diagnose wryneck caused by more hard-to-spot abnormalities or conditions. These can include degenerative arthritis of the spine.

In some instances, what may appear as wryneck could be something more serious.

If a person experiences any of the following symptoms, they should seek immediate medical assistance:

  • muscle spasms in the neck after an injury
  • difficulty swallowing
  • difficulty breathing
  • problems walking
  • impaired speech
  • weakness or numbness in the arms and legs
  • difficulty passing urine
  • urinary or fecal incontinence
  • swelling of the mouth or tongue
  • fever
  • swollen glands
  • a headache

Treatment options

Icepack being applied to the neck due to wryneck
Treatments for wryneck can include medication and ice packs.

Treatment for wryneck depends on the type and cause.

Some instances of wryneck can disappear within a few days if the person rests and avoids moving their neck.

Treatments for wryneck include:

  • ice packs
  • medication
  • physical devices to keep the neck fixed in place
  • physical therapy
  • massage therapy
  • stretching exercises
  • surgery

A doctor may prescribe muscle relaxants and anti-inflammatory drugs for spasmodic torticollis caused by injury or as a side effect of medications.

In cases of chronic neck muscle spasms and cervical dystonia, botulinum A toxin, also known as Botox, may provide relief by preventing the muscles from contracting. Botox may also prevent the condition from progressing.

Surgery can help avoid further symptoms if other forms of treatment do not work. A surgeon may cut certain nerves and muscles to stop them contracting.

Around 10 percent of children who have wryneck from birth will require surgery to lengthen the sternocleidomastoid muscle in the neck. This surgery will likely take place once the child reaches preschool age.

Brain stimulation is a rare treatment option. A doctor can do this by inserting a wire into the part of the brain that controls movement and disrupts the brain signals. Brain stimulation may help with cervical dystonia.

People with wryneck can also try home remedies to help manage symptoms of pain and discomfort. These remedies include:

  • Sleeping and getting plenty of rest. Wryneck symptoms may disappear during sleep, so getting plenty of rest and lying down can help to ease symptoms and bring relief.
  • Using heat packs or ice packs. These devices can relieve pain and soothe tight muscles.
  • Touching the opposite side of the face, chin, or neck. Doing this can trick the body and could help to stop spasms temporarily.
  • Reducing stress. Stress can cause muscles to tighten and may worsen wryneck symptoms. Knowing what triggers stress and using stress-reduction techniques can help to manage symptoms.
  • Stretching exercises. These may include gradually trying to move the head in the opposite direction, further and further each time, and can help to improve motion and ease discomfort.

People may want to speak to a physical therapist before attempting any stretches for wryneck.

In infants with wryneck, stretching can also help. Encouraging the baby to turn their head in both directions can relieve tension and build strong neck muscles. Using stimuli, such as noise and lights, can also encourage babies to move their heads.

A physical therapist can perform more intensive treatment on infants with wryneck and can advise on stretches to try at home.


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Outlook

Wryneck is not always preventable, but prompt treatment can cure it or stop it from becoming worse.

There are many treatment options for managing symptoms and reducing how often they occur, and the outlook for people with this condition is usually good.

Nevertheless, people can become disabled from wryneck, particularly if they leave the condition untreated. They may find they have difficulty doing daily activities, such as driving, and they might experience persistent pain and discomfort.

Early intervention and physical therapy can help successfully treat infants and children with wryneck and prevent the condition from worsening.

In more severe cases, surgery on the nerves and muscles of the neck is an option, though the condition can still return.

In many cases, however, and with the right treatment, wryneck will go away within a few days or weeks.

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