Wry Neck(acute torticollis)

Description

Also known as acute torticollis.

Wry neck is a condition where the neck develops sudden pain and limitation to movement and is often associated with muscle spasm. Wry neck is a common condition which severely impacts the life of the patient because of the limitation the sufferer experiences with even the most simple activities e.g. turning to look over your shoulder when driving.

There are two types of wry neck;

  1. Apophyseal wry neck.
  2. Discogenic wry neck.

Apophyseal wry neck

Apophyseal wry neck generally occurs in the population under 30 and involves the apophyseal joint(facet joint). There are numerous causes of apophyseal wry neck

  • A sudden movement followed by a sharp pain caused by a locking of the apophyseal joint.
  • Poor sleep causing stiffness and pain on waking in the morning.
  • Unknown causes.

This condition causes the patient to flex their neck away from the side of the injured joint and they are unable to correct this posture due to pain and muscle spasm.

Discogenic wry neck

Discogenic wry neck typically occurs in the older population and involves the intervertebral discs. The typical presentation is a gradual onset pain developing after a long sleep in an awkward posture. This condition occurs because the intervertebral disc is displaced and the presses on the surrounding structures.

Symptoms

Apophyseal wry neck

Common symptoms include:

  • Severe one sided sharp neck pain.
  • Stuck neck, bent away from the affected joint.
  • Aggravated by movement to the affected side.
  • Muscle spasm in neck and down upper back.

Discogenic wry neck

Common symptoms include:

  • Pain maximally felt in lower neck and upper thoracic spine.
  • Severe one sided neck pain.
  • Flexed away from the affected side more due to pain then being stuck.
  • Muscle spasm.

Treatment

It is important to diagnosis the two different types of wry neck because the treatment for apophyseal wry neck can aggravate the discogenic wry neck.

Apophyseal wry neck

Physiotherapy treatments consist of:

  • Mobilisation and mobilisations with movements of the affected apophyseal joint.
  • Massage to relieve the muscle spasm in the neck.
  • Postural education.
  • Stretches to restore proper muscle length.

Discogenic wry neck

Physiotherapy treatments consist of:

  • Traction away from the affected side.
  • Massage to relieve the muscle spasm in the neck and upper back.
  • Postural education.
  • Stretches to restore proper muscle length.