Volume 18, Issue 12 p. 1482-1491
Research Article

Posttraumatic painful torticollis

Daniel S. Sa MD

Daniel S. Sa MD

Movement Disorders Unit, Toronto Western Hospital, University of Toronto, Ontario, Canada

Search for more papers by this author
Angela Mailis-Gagnon MD, FRCPC

Angela Mailis-Gagnon MD, FRCPC

Comprehensive Pain Program, Toronto Western Hospital, University of Toronto, Ontario, Canada

Search for more papers by this author
Keith Nicholson PhD

Keith Nicholson PhD

Comprehensive Pain Program, Toronto Western Hospital, University of Toronto, Ontario, Canada

Search for more papers by this author
Anthony E. Lang MD, FRCPC

Corresponding Author

Anthony E. Lang MD, FRCPC

Movement Disorders Unit, Toronto Western Hospital, University of Toronto, Ontario, Canada

Toronto Western Hospital, 399 Bathurst Street, MP 11-306, Toronto, ON, Canada M5T 2S8Search for more papers by this author
First published: 24 September 2003
Citations: 59

Abstract

The development of abnormal posturing of the neck or shoulder after local injury has been termed posttraumatic cervical dystonia (PTCD). Certain features seem to distinguish a unique subgroup of patients with this disorder from those with features more akin to typical idiopathic cervical dystonia, such as onset and maximum disability that occurs very quickly after injury, severe pain and a fixed abnormal posture. In an attempt to clarify the nature of this syndrome further, we evaluated 16 such patients (8 men, 8 women). Motor vehicle accident and work-related injuries were common precipitants, with posturing usually developing shortly after trauma, and little progression occurring after the first week. A characteristic, painful, fixed head tilt and shoulder elevation were present in all but one patient, who had a painless elevated shoulder and painful contralateral shoulder depression, as well as nondermatomal sensory loss in 14 patients. Additional abnormalities included dystonic posturing in a limb (2 patients) or jaw (1 patient), limb tremor (3 patients) and “give-way” limb weakness (8 patients). The tremor and the jaw dystonia demonstrated features suggestive of a psychogenic movement disorder, most commonly distractibility. Litigation or compensation was present in all 16 patients. Intravenous sodium amytal improved the posture, pain or both in 13 of 13 patients; in 7 of 13 the sensory deficit either markedly improved or normalized. General anesthesia demonstrated full range of motion in all 5 patients assessed. Psychological evaluations suggested that psychological conflict, stress, or both were being expressed via somatic channels in 11 of 12 tested patients. Our results suggest an important role of psychological factors in the etiology or maintenance of abnormal posture, pain and associated disability of these patients. The role of central factors triggered in psychologically vulnerable individuals after physical trauma is discussed. We propose that the disorder be referred to as “posttraumatic painful torticollis” rather than characterize it as a form of dystonia until further information on its pathogenesis is forthcoming. © 2003 Movement Disorder Society