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Copyright (c) 2025 Razan Falah Matar Aljameeli, Salem Ali Alolayan, Tahani Saad Alshahrani, Mohammed Mahmoud Mousa Alameer, Mohammad Ahmad Sharahily, Bayan Abdulaziz Mustafa, Abdulmajeed Hussain Hassan Zughaibi, Badriyah Jamal Mosa Alkibari, Abeer Yahya Oqiesh, Naif Abdulaziz Nawi Alonazi, Mohammed Yousef Mohammed Khawaji, Mohammed Yousef Mohammed Khawaji, Bader Khalid Ghayib Alghubaywi, Amr Ghazi Hamed Almaghamsi
This work is licensed under a Creative Commons Attribution 4.0 International License.
Torticollis: Multidisciplinary Clinical Evaluation and Management in Physiotherapy, Radiology, and General Medicine
Corresponding Author(s) : Razan Falah Matar Aljameeli
Saudi Journal of Medicine and Public Health,
Vol. 2 No. 2 (2025)
Abstract
Background: Torticollis, also known as twisted neck, is a common clinical condition characterized by abnormal head and neck posture resulting from involuntary muscular contractions or structural abnormalities. It affects individuals across all age groups and may range from benign, selflimiting presentations to manifestations of serious neurological or systemic disease. Due to its heterogeneous etiology and variable clinical presentation, torticollis requires careful multidisciplinary evaluation.
Aim: This article aims to provide a comprehensive overview of torticollis, emphasizing its etiology, clinical presentation, diagnostic evaluation, and management strategies from a multidisciplinary healthcare perspective.
Methods: A narrative clinical review approach was employed, integrating current medical, physiotherapeutic, neurological, and radiological perspectives on torticollis. The review synthesizes anatomical, epidemiological, and clinical data to support evidencebased assessment and treatment.
Results: Torticollis is broadly classified into congenital and acquired forms, with etiologies including musculoskeletal, dermatogenic, ocular, vestibular, rheumatological, and neurogenic causes. Cervical dystonia represents the most prevalent form of adults, often involving the sternocleidomastoid and surrounding cervical muscles. Clinical evaluation remains the cornerstone of diagnosis, supported by imaging and laboratory investigations in selected cases. Management is individualized and commonly involves conservative measures such as physiotherapy, pharmacologic therapy, botulinum toxin injections, and, in refractory or structural cases, surgical intervention.
Conclusion: Early recognition and accurate etiological diagnosis of torticollis are essential to optimize outcomes, minimize complications, and improve quality of life. A coordinated interprofessional approach is critical for effective longterm management.
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- Bleton JP. Physiotherapy of focal dystonia: a physiotherapist's personal experience. European journal of neurology. 2010 Jul:17 Suppl 1():107-12. doi: 10.1111/j.1468-1331.2010.03061.x.
- Nucci P, Kushner BJ, Serafino M, Orzalesi N. A multi-disciplinary study of the ocular, orthopedic, and neurologic causes of abnormal head postures in children. American journal of ophthalmology. 2005 Jul:140(1):65-8
- Lee JH, Cheng KL, Choi YJ, Baek JH. High-resolution Imaging of Neural Anatomy and Pathology of the Neck. Korean journal of radiology. 2017 Jan-Feb:18(1):180-193. doi: 10.3348/kjr.2017.18.1.180.
- Kohan EJ,Wirth GA, Anatomy of the neck. Clinics in plastic surgery. 2014 Jan
- van den Dool J, Visser B, Koelman JH, Engelbert RH, Tijssen MA. Long-Term Specialized Physical Therapy in Cervical Dystonia: Outcomes of a Randomized Controlled Trial. Archives of physical medicine and rehabilitation. 2019 Aug:100(8):1417-1425. doi: 10.1016/j.apmr.2019.01.013.
- Garg M, Sridhar MS, Verma S, Bhadoria J. Unprecedented complication of odontoid regeneration after transoral odontoidectomy. Journal of craniovertebral junction & spine. 2018 Oct-Dec:9(4):280-282. doi: 10.4103/jcvjs.JCVJS_98_18.
- Tomczak KK, Rosman NP. Torticollis. Journal of child neurology. 2013 Mar:28(3):365-78. doi: 10.1177/0883073812469294.
- Per H,Canpolat M,Tümtürk A,Gumuş H,Gokoglu A,Yikilmaz A,Özmen S,Kaçar Bayram A,Poyrazoğlu HG,Kumandas S,Kurtsoy A, Different etiologies of acquired torticollis in childhood. Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery. 2014 Mar
- Natarajan A, Yassa JG, Burke DP, Fernandes JA. Not all cases of neck pain with/without torticollis are benign: unusual presentations in a paediatric accident and emergency department. Emergency medicine journal : EMJ. 2005 Sep:22(9):646-9
- De Pauw J, Mercelis R, Hallemans A, Michiels S, Truijen S, Cras P, De Hertogh W. Cervical sensorimotor control in idiopathic cervical dystonia: A cross-sectional study. Brain and behavior. 2017 Sep:7(9):e00735. doi: 10.1002/brb3.735.
- Skogseid IM. Dystonia--new advances in classification, genetics, pathophysiology and treatment. Acta neurologica Scandinavica. Supplementum. 2014:(198):13-9. doi: 10.1111/ane.12231.
- Kaplan SL, Dole RL, Schreiber J. Uptake of the Congenital Muscular Torticollis Clinical Practice Guideline Into Pediatric Practice. Pediatric physical therapy : the official publication of the Section on Pediatrics of the American Physical Therapy Association. 2017 Oct:29(4):307-313. doi: 10.1097/PEP.0000000000000444.
- Pharisa C, Lutz N, Roback MG, Gehri M. Neck complaints in the pediatric emergency department: a consecutive case series of 170 children. Pediatric emergency care. 2009 Dec:25(12):823-6. doi: 10.1097/PEC.0b013e3181c06062.
- Carenzio G, Carlisi E, Morani I, Tinelli C, Barak M, Bejor M, Dalla Toffola E. Early rehabilitation treatment in newborns with congenital muscular torticollis. European journal of physical and rehabilitation medicine. 2015 Oct:51(5):539-45
- Dressler D, Kupsch A, Seitzinger A, Paus S. The dystonia discomfort scale (DDS): a novel instrument to monitor the temporal profile of botulinum toxin therapy in cervical dystonia. European journal of neurology. 2014 Mar:21(3):459-62. doi: 10.1111/ene.12330.
- van den Dool J, Visser B, Koelman JH, Engelbert RH, Tijssen MA. Cervical dystonia: effectiveness of a standardized physical therapy program; study design and protocol of a single blind randomized controlled trial. BMC neurology. 2013 Jul 15:13():85. doi: 10.1186/1471-2377-13-85.
- Lim KS, Shim JS, Lee YS. Is sternocleidomastoid muscle release effective in adults with neglected congenital muscular torticollis? Clinical orthopaedics and related research. 2014 Apr:472(4):1271-8. doi: 10.1007/s11999-013-3388-6.
References
Bleton JP. Physiotherapy of focal dystonia: a physiotherapist's personal experience. European journal of neurology. 2010 Jul:17 Suppl 1():107-12. doi: 10.1111/j.1468-1331.2010.03061.x.
Nucci P, Kushner BJ, Serafino M, Orzalesi N. A multi-disciplinary study of the ocular, orthopedic, and neurologic causes of abnormal head postures in children. American journal of ophthalmology. 2005 Jul:140(1):65-8
Lee JH, Cheng KL, Choi YJ, Baek JH. High-resolution Imaging of Neural Anatomy and Pathology of the Neck. Korean journal of radiology. 2017 Jan-Feb:18(1):180-193. doi: 10.3348/kjr.2017.18.1.180.
Kohan EJ,Wirth GA, Anatomy of the neck. Clinics in plastic surgery. 2014 Jan
van den Dool J, Visser B, Koelman JH, Engelbert RH, Tijssen MA. Long-Term Specialized Physical Therapy in Cervical Dystonia: Outcomes of a Randomized Controlled Trial. Archives of physical medicine and rehabilitation. 2019 Aug:100(8):1417-1425. doi: 10.1016/j.apmr.2019.01.013.
Garg M, Sridhar MS, Verma S, Bhadoria J. Unprecedented complication of odontoid regeneration after transoral odontoidectomy. Journal of craniovertebral junction & spine. 2018 Oct-Dec:9(4):280-282. doi: 10.4103/jcvjs.JCVJS_98_18.
Tomczak KK, Rosman NP. Torticollis. Journal of child neurology. 2013 Mar:28(3):365-78. doi: 10.1177/0883073812469294.
Per H,Canpolat M,Tümtürk A,Gumuş H,Gokoglu A,Yikilmaz A,Özmen S,Kaçar Bayram A,Poyrazoğlu HG,Kumandas S,Kurtsoy A, Different etiologies of acquired torticollis in childhood. Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery. 2014 Mar
Natarajan A, Yassa JG, Burke DP, Fernandes JA. Not all cases of neck pain with/without torticollis are benign: unusual presentations in a paediatric accident and emergency department. Emergency medicine journal : EMJ. 2005 Sep:22(9):646-9
De Pauw J, Mercelis R, Hallemans A, Michiels S, Truijen S, Cras P, De Hertogh W. Cervical sensorimotor control in idiopathic cervical dystonia: A cross-sectional study. Brain and behavior. 2017 Sep:7(9):e00735. doi: 10.1002/brb3.735.
Skogseid IM. Dystonia--new advances in classification, genetics, pathophysiology and treatment. Acta neurologica Scandinavica. Supplementum. 2014:(198):13-9. doi: 10.1111/ane.12231.
Kaplan SL, Dole RL, Schreiber J. Uptake of the Congenital Muscular Torticollis Clinical Practice Guideline Into Pediatric Practice. Pediatric physical therapy : the official publication of the Section on Pediatrics of the American Physical Therapy Association. 2017 Oct:29(4):307-313. doi: 10.1097/PEP.0000000000000444.
Pharisa C, Lutz N, Roback MG, Gehri M. Neck complaints in the pediatric emergency department: a consecutive case series of 170 children. Pediatric emergency care. 2009 Dec:25(12):823-6. doi: 10.1097/PEC.0b013e3181c06062.
Carenzio G, Carlisi E, Morani I, Tinelli C, Barak M, Bejor M, Dalla Toffola E. Early rehabilitation treatment in newborns with congenital muscular torticollis. European journal of physical and rehabilitation medicine. 2015 Oct:51(5):539-45
Dressler D, Kupsch A, Seitzinger A, Paus S. The dystonia discomfort scale (DDS): a novel instrument to monitor the temporal profile of botulinum toxin therapy in cervical dystonia. European journal of neurology. 2014 Mar:21(3):459-62. doi: 10.1111/ene.12330.
van den Dool J, Visser B, Koelman JH, Engelbert RH, Tijssen MA. Cervical dystonia: effectiveness of a standardized physical therapy program; study design and protocol of a single blind randomized controlled trial. BMC neurology. 2013 Jul 15:13():85. doi: 10.1186/1471-2377-13-85.
Lim KS, Shim JS, Lee YS. Is sternocleidomastoid muscle release effective in adults with neglected congenital muscular torticollis? Clinical orthopaedics and related research. 2014 Apr:472(4):1271-8. doi: 10.1007/s11999-013-3388-6.