Torticollis: The Daily PANCE Blueprint

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Torticollis: The Daily PANCE Blueprint

A 6-year-old male presents with an acute onset of painful neck stiffness and holds his head tilted to the right with his chin rotated to the left. He has fever and difficulty swallowing. On exam, he resists passive neck extension. Which of the following is the most important condition to rule out first?

A. Retropharyngeal abscess
B. Congenital muscular torticollis
C. Chiari malformation
D. Ligamentous laxity due to Trisomy 21
E. Bacterial meningitis

Answer and topic summary

The answer is A. Retropharyngeal abscess

Torticollis (“wryneck”) is defined by lateral twisting of the neck. It causes the head to tilt to one side and the chin to face the opposite direction. It can be congenital or acquired. Here is a list of causes: trauma, head/neck infections, inflammation, neoplasms, ligamentous laxity (due to Trisomy 21, osteogenesis imperfecta, etc.), Chiari malformation, vascular abnormalities, etc. Especially in acquired torticollis, it’s important to rule out an infection in the neck area (e.g., retropharyngeal abscess, Lemierre syndrome, etc.). Treatment depends on the underlying cause.

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Covered under ⇒ PANCE Blueprint Musculoskeletal ⇒ Spinal Disorders ⇒ Torticollis

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