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A wry neck, or torticollis, is usually precipitated by sudden and severe neck pain, which causes contractions of neck muscles. This condition causes the inability to maintain a normal central head position, usually causing the head to be turned to one side. Sometimes wry neck can develop slowly after minimal head turning, after a vigorous jerking or movement, or even during sleep. Sometimes the individual will awaken from his sleep to excruciating neck pain, for which he may assume is secondary to an awkward sleeping position.
Frequently, wry neck is related to a spasm in the trapezius or scapulae muscles, or it can be related to a herniated disc or a bacterial or viral infection. Generally, the primary complaint of the patient is severe unilateral neck pain and resultant immobility. The pain is often more severe in the lower neck area. Typically, pain radiates downwards to the scapula and onto the shoulder, causing significant shoulder pain. In addition, the individual may develop a pronounced headache, head tremor, and may experience limited range of motion of his neck and arms.
Generally, diagnosis of wry neck is made after a physical examination, when the physician notes the patient's significant pain and inability to maintain proper posture. In addition, the medical exam will reveal diminished range of motion and possible sluggish reflexes of the tricep and bicep muscles. Diminished reflexes may indicate nerve root involvement and may signify a herniated disc. In addition to the physical examination, the physician will also take an oral medical history report from the patient. He may ask the patient in what activity he was engaged in prior to the onset of his pain and disability.
Typically, treatment for wry neck includes heat, anti-inflammatory medications, and muscle relaxant medications. Although heat is very soothing for wry neck, alternating with ice packs may be more effective. Ice not only reduces pain, but helps reduce resultant tissue swelling as well.
Generally, anti-inflammatory medications are effective in reducing pain and inflammation, however, stronger prescription pain medications may be indicated when pain is intractable, or severe. Many prescription pain relievers are opiate-based and can cause significant side effects such as drowsiness, dizziness, and constipation. The patient should discuss these side effects with his doctor before taking them.
Sometimes, the patient may be referred to participate in a physical therapy regime. Physical therapy programs can help restore mobility and reduce pain. In certain cases of wry neck, conventional therapies may be ineffective at relieving pain. In these situations, the patient may be referred to a doctor who specializes in orthopedics for further evaluation, and possible surgical intervention. Usually, the patient makes a full recovery, though sometimes the condition may return.
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