Todays episode and Tweetorial of “Old man shouting a clouds” is on all things Torticollis. It is important to understand th proposals in the prior episodes regarding head joint, neck joint and the coupling myth to understand Torticollis.
I will also discuss the development and formation of the euncovertebral joint from childhood to early adulthood. It is part of the understanding and an important puzzle piece in the true movement and axis of rotation for the neck joints.
First I will discuss the uncovertebral joint, which is often overlooked and mistaken for degenerative changes in the neck joints. The uncovertebral joint or Joints of Von Luschka , are formative joints (only found in bipeds or facultory bipeds). The joint is formed as...
Our annulus becomes less elastic and boney projections develop on the posterolateral aspect of the cervical vertebral bodies
I will be posting several references and full text papers at the end to allow review of this.
The development of the joint occurs due to functional rotation of the head on the neck, the pull of the annulus remodels the bone of the vertebral body, at around age nine the annulus starts to fracture and uncovertebral clefts develop in the posterior lateral disc,
These clefts continue to develop and the boney changes continue until around age 21 when the posterior disc of the lower neck may be fissured completely in th eposterior aspect and through 50% of the disc postero-anteriorly (see Mercer and Bogduk)
This age related developmental fissuring and formation of the uncovertebral joint ha sheen shown to be important in juvenile torticollis. The joints formation is also important for functional head and neck rotation. Penning showed that the true axis of neck rotation can be mapped
Through the uncovertebral joint (as discussed in previous episode) so the uncoverterbal joint is a developmental joint due to functional head and neck rotation. These joins are seen in humans, Kangaroos, Meerkats and Rats
Torticollis is most common in adolescent years, I will discuss briefly the types of Torticollis later in this long thread.
It is not uncommon for young teenagers to wake up or do a sudden movement and develop torticolis. It can be quite worrying fo parents & child
Hypotheses for juvenile torticollis are sternomastod spasm, facet joint locking , subluxing AA joint and discogenic issues. I will suggest it is mst common to have discogenic torticollis in adolescents due to formation of the uncovertebral joint clefts
This was described in the paper above link here
To differentiate between torticollis from sternomastoid spasm and the neck joints we can utilize our previous knowledge of head joints, neck joints and muscle action. Sternomastoid spasm would lock the head
And neck into rotation and side bending as in the first picture above, a simple test of asking the patinet to look at their shoulder allows you to see if the head and neck are fixed due to spasm, if the patinet can look as the shoulder the problem is the neck joints not muscle.
This is application of previous information, knowing the head can rotate independent of the neck, the patient assumes the forward tilt position so they can look forward. This fits with Maine’s MRI observation and treatment is thus aimed at the neck.
The treatment in children is reassurance of parent and child, normally treatment is easiest supine with head supported on a pillow. Gently encouraging the neck to near neutral then using head rotation (50% of total rotation will be available) to gentely mobilize the neck joints
In the direction opposite to the deformity. This is similar to the treatment described by Mulligan, I spent time with him in the mid 90s and discussed this with him. The neck often unlocks quite quickly, even if it doesn’t reassurance that nothing is serious is encouraging
Most adolescent torticollis lasts about three days and spontaneously resolves, if it doesn’t futher investigation may be warranted.
Torticollis is common in new born infants, often from position in the womb, small bleeds in to sternomastoid (fibromatosis colli), ocular issues and some serious pathology. In most babies stretching taught to parents is the treatment strategy. Reassurance is again a key part.
There is a nice review here
Torticollis in adults is not commo but often occurs as part of a neurological disorder dystonia and is often a muscular toxicity issue and often tremulous see here 
Treatment of dystonia type muscular torticollis is often treated with Botox therapy and stretching exercises.
Again utilizing the differentiation test in adult torticollis will be useful to decide if this is muscular or neck related.
If the adult torticollis is not muscular similar treatment approaches described previously s utilizing self treatment exercises can be attempted.
Thanks for reading I hope this makes sense and you find it linially applicable. Stay safe.
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