Кривошея: причины, виды и диагностика

Torticollis, also known as wry neck, is a painful, dystonic condition defined by an abnormal, asymmetrical head or neck position, which may be due to a variety of causes. The term torticollis is derived from the Latin words tortus, meaning "twisted", and collum, meaning "neck". The most common case has no obvious cause, and the pain and difficulty with turning the head usually goes away after a few days, even without treatment in adults.

A multitude of conditions may lead to the development of torticollis including: muscular fibrosis, congenital spine abnormalities, or toxic or traumatic brain injury. Other categories include: Congenital muscular torticollis is the third most common congenital musculoskeletal deformity in children. The cause of congenital muscular torticollis is unclear. Birth trauma or intrauterine malposition is considered to be the cause of damage to the sternocleidomastoid muscle in the neck. Any of these mechanisms can result in a shortening or excessive contraction of the sternocleidomastoid muscle, which curtails its range of motion in both rotation and lateral bending. The head is typically tilted in lateral bending toward the affected muscle and rotated toward the opposite side. In other words, the head itself is tilted in the direction of the shortened muscle, with the chin tilted in the opposite direction. Congenital torticollis is presented at 1–4 weeks of age, and a hard mass usually develops. It is normally diagnosed using ultrasonography and a color histogram or clinically by evaluating the infant's passive cervical range of motion. Congenital torticollis constitutes the majority of cases seen in paediatric clinical practice. Sometimes a mass, such as a sternocleidomastoid tumor, is noted in the affected muscle. Congenital Muscular Torticollis is also defined by a fibrosis contracture of the sternocleidomastoid muscle on one side of the neck. Secondary complications associated with Congenital Muscular Torticollis include visual dysfunctions, facial asymmetry, delayed development, cervical scoliosis, and vertebral wedge degeneration which will have a serious impact on the child's appearance and even mental health.

Torticollis with recurrent, but transient contraction of the muscles of the neck and especially of the sternocleidomastoid, is called spasmodic torticollis. Synonyms are "intermittent torticollis", "cervical dystonia" or "idiopathic cervical dystonia", depending on cause.

Torticollis can be caused by damage to the trochlear nerve (fourth cranial nerve), which supplies the superior oblique muscle of the eye. The superior oblique muscle is involved in depression, abduction, and intorsion of the eye. When the trochlear nerve is damaged, the eye is extorted because the superior oblique is not functioning. The affected person will have vision problems unless they turn their head away from the side that is affected, causing intorsion of the eye and balancing out the extorsion of the eye. This can be diagnosed by the Bielschowsky test, also called the head tilt test, where the head is turned to the affected side. A positive test occurs when the affected eye elevates, seeming to float up.

Teaching people how to sit and stand properly can help reduce strain on the neck muscles and improve posture. Changing habits like bad posture or repetitive movements can help ease symptoms of torticollis. Wearing a special collar can also support the neck and keep it in the right position during daily activities. Using electrical devices have also been shown to reduce pain, make muscles work better, and relax tight muscles. Injecting a substance like Botox into overactive muscles can weaken them temporarily, allowing for better movement. If other treatments don't work, surgery might be needed to fix the muscles or bones causing torticollis.

Physical therapy is an option for treating torticollis in a non invasive and cost effective manner. In the children above 1 year of age, surgical release of the tight sternocleidomastoid muscle is indicated along with aggressive therapy and appropriate splinting. Occupational therapy rehabilitation in Congenital muscular torticollis concentrates on observation, orthosis, gentle stretching, myofascial release techniques, parents’ counseling training, and home exercise program. While outpatient infant physiotherapy is effective, home therapy performed by a parent or guardian is just as effective in reversing the effects of congenital torticollis.

A meta analysis shows physical therapists specializing in manual therapy have developed effective interventions for the management of Congenital Muscular Torticollis (CMT), primarily centered around massage and passive stretching techniques. These interventions are tailored to address the specific needs of pediatric patients, with a focus on stretching the sternocleidomastoid muscle. This review did not report any adverse effects of using manipulation techniques. It was shown that using manipulation techniques on their own had little to no statistical differences from a placebo group, immediately. When manipulation techniques were combined with physical therapy, there was a change in symptoms compared to the use of physical therapy alone. When targeting the cervical spine, manipulation techniques were shown to shorten treatment duration in infants with head asymmetries. Microcurrent therapy is completely painless and children can only feel the probe from the machine on their skin.

Surgical release involves the two heads of the sternocleidomastoid muscle being dissected free. This surgery can be minimally invasive and done laparoscopically. Usually surgery is performed on those who are over 12 months old. The surgery is for those who do not respond to physical therapy or botulinum toxin injection or have a very fibrotic sternocleidomastoid muscle.

CMT is a neck problem that babies are born with or develop soon after birth, causing their neck to be stiff and bent in an awkward position. It is possible that torticollis will resolve spontaneously, but chance of relapse is possible.