eMedicine Specialties > Neurology > Movement and Neurodegenerative Diseases

Torticollis: Follow-up

Author: Norman C Reynolds Jr, MD, Neurologist, Veterans Affairs Medical Center of Milwaukee
Coauthor(s): Jianxin Ma, MD, Staff Physician, Department of Physical Medicine and Rehabilitation, Johns Hopkins University Hospital
Contributor Information and Disclosures

Updated: Dec 10, 2008

Follow-up

Further Outpatient Care

Regular outpatient visits are needed for routine medication checkups and repeat botulinum toxin injections.

Patient Education

  • Patients must understand that their condition is expected to wax and wane with emotions and that this phenomenon does not make their condition a psychological problem. Failure to understand this results in a poor self-image and an unnecessary interest in tranquilizers.
  • For excellent patient education resources, visit eMedicine's Back, Ribs, Neck, and Head Center. Also, see eMedicine's patient education articles Torticollis and Whiplash.

Miscellaneous

Medicolegal Pitfalls

  • Distinguishing acute cervical trauma from traumatic torticollis may be difficult but is a recurring theme for car accident victims with persisting whiplash symptoms or for patients with industrial injuries when legal interest or chronic pain is an issue. Precise chronologic history is required in providing testimony to distinguish acute cervical trauma from posttraumatic torticollis. To maintain credibility during testimony, consistent statements of chronology are critical and must be prepared by careful review of the medical record by the physician giving testimony.
    • Postconcussive syndrome: Whiplash head and neck injury from rapid acceleration and/or deceleration involves sprained and painful neck muscles, usually on both sides and the posterior muscles, along with global headache, inability to concentrate, and often dizziness and blurred vision.
    • Acute posttraumatic torticollis: Although beginning a few days or immediately following whiplash or other trauma, this can be defined clearly only when the postconcussive syndrome is minimal. When the postconcussive syndrome is of great magnitude and persistent, acute posttraumatic torticollis can be identified clearly only after the acute strain and other postconcussive symptoms are eliminated in time or by analgesic medication (short-term narcotics or NSAIDs). "Residuals" of consistent abnormal head and neck posture with marked limitation of motion are not from the postconcussive syndrome (which is self-limited) but rather from acute posttraumatic torticollis (which is likely to be a chronic syndrome requiring botulinum toxin or a D2 agonist for long-term treatment).
  • Delayed posttraumatic torticollis: This is not a recurrence of the postconcussive or whiplash syndrome in the absence of a new injury but an identifiable torticollis syndrome with persistent abnormal posture of head and neck with major limitation in motion. The history of a previous whiplash or postconcussive syndrome establishes the original trauma that may eventually lead to torticollis due to intracranial brain changes in physiology as a delayed response to the original trauma.
 


More on Torticollis

Overview: Torticollis
Differential Diagnoses & Workup: Torticollis
Treatment & Medication: Torticollis
Follow-up: Torticollis
Multimedia: Torticollis
References
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References

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Further Reading

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Keywords

retrocollis, anterocollis, laterocollis, rotational torticollis, spasmodic torticollis, cervical dystonia, idiopathic cervical dystonia, segmental dystonia of head and neck, head and neck dystonia, head tremor, head tilt, head jerks, head spasms

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Contributor Information and Disclosures

Author

Norman C Reynolds Jr, MD, Neurologist, Veterans Affairs Medical Center of Milwaukee
Norman C Reynolds Jr, MD is a member of the following medical societies: American Academy of Neurology, Association of Military Surgeons of the US, Movement Disorders Society, Sigma Xi, and Society for Neuroscience
Disclosure: Nothing to disclose.

Coauthor(s)

Jianxin Ma, MD, Staff Physician, Department of Physical Medicine and Rehabilitation, Johns Hopkins University Hospital
Disclosure: Nothing to disclose.

Medical Editor

Stephen T Gancher, MD, Adjunct Associate Professor, Department of Neurology, Oregon Health Sciences University
Stephen T Gancher, MD is a member of the following medical societies: American Academy of Neurology, American Neurological Association, and Movement Disorders Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Nestor Galvez-Jimenez, MD, MSc, MHA, Chairman, Department of Neurology, Program Director, Movement Disorders, Department of Neurology, Division of Medicine, Cleveland Clinic Florida
Nestor Galvez-Jimenez, MD, MSc, MHA is a member of the following medical societies: American Academy of Neurology, American College of Physicians, and Movement Disorders Society
Disclosure: Nothing to disclose.

CME Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

 
 
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