1911 Encyclopædia Britannica/Wry-neck

WRY-NECK (Lat. Torticollis), a congenital or acquired deformity, characterized by the affected side of the head being drawn downwards toward the shoulder together with deviation of the face, toward the sound side. There are various forms. (1) The congenital, due to a lesion of the sterno-mastoid muscle, either the result of a malposition in utero or due to the rupture of the muscle in the delivery of the aftercoming head in the birth of the breech presentation. (2) The rheumatic, due to exposure to a draught or cold. This is commonly known as “stiff-neck.” (3) The nervous or spasmodic, the result of (a) direct irritation of the spinal accessory nerve or its roots, or (b) the result of cerebral irritation. In this form there is generally a family history of nervous diseases, notably epilepsy. This spasm is one of a group of nervous spasms known as “tics,” a variety of habit spasm. The character of the movements varies with the muscles involved, the most usual muscle being the sterno-mastoid. The spasm ceases during sleep. Many cases are also due to hysteria and some to spinal caries. When wry-neck is congenital, massage and manipulation may be tried and some form of apparatus. Failing this, division of the muscle surgically may be practiced. In the spasmodic forms, anti-neurotic treatment is recommended, the use of the bromides, valerianates and belladonna, and hydrobromide of hyoscine injected into the muscles has been found of value. T. Grainger Stewart recommends in persistent tic the trial of continuous and regular movements in the affected group of muscles with a view to replacing the abnormal movements by normal ones. In severe cases it may be necessary to cut down on and stretch or excise the spinal accessory nerve. In rheumatic torticollis the spasm is usually overcome by the application of hot compresses and appropriate anti-rheumatic treatment.