05/28/2013 // Concord, CA, USA // LifeCare123 // Greg Vigna, MD, JD, Joe Motta, JD // (press release)
(LifeCare123.com News)
Medical Perspective:
Torticollis is a condition that is the result of sustained contractions of the muscles of the neck, which produces distortions in posture, pain, and sometimes gross disfigurement. Studies indicate that between 11 and 21 percent of patients with this condition have sustained an injury to the head, neck or shoulder within on year of the development of torticollis sometimes referred to as cervical dystonia. Posttraumatic torticollis is believed to be unique and distinct from the more common ‘idiopathic torticollis’ which occurs because of unknown causes.
Trauma causes pain from various sources such as soft tissue injury, peripheral nerve injury, disc herniation, spinal cord injury, and traumatic brain injury. Somehow, trauma alters the central nervous system which can lead to over activity/over contraction of specific neck muscles. This causes abnormal posture.
Posttraumatic torticollis produces a limited range of motion to nearly a fixed position, there is no improvement following sleep, and Botox treatments have had inferior results compared with its use in idiopathic torticollis patients. It is not uncommon for Reflex Sympathetic Dystrophy to occur with posttraumatic torticollis.
Posttraumatic torticollis may arise from both soft tissue injuries as well as injuries to either the central or peripheral nervous system. It is common for posttraumatic torticollis to occur relatively early following an injury. Diagnostic test should include an MRI of the cervical spine to rule out a significant problem involving the spinal cord or nerve roots. Treatment initially should consist of anti-inflammatories, physical therapy, modalities such as ultrasound and electric stimulation, and trial of traction in cases of cervical disc derangements. From my experience I believe patients with posttraumatic torticollis should undergo early intervention with Botox into the offending muscles. If symptoms consistent with RSD develop, aggressive physical therapy for desensitization should be employed. To facilitate a program at achieving functional restoration of the involved extremity, I would consider aggressive active physical therapy, and a stellate ganglion block.
The response to Botox in patients with posttraumatic torticollis is generally not as positive as it with idiopathic torticollis patients. Patients with either torticollis, who do not respond favorably to Botox, should be referred to a recognized center of excellence for either spasticity or movement disorders. There, they should consider higher doses of Botox as well as surgical intervention to disrupt the nerve supply to the offending muscles.
Life Care Planner Perspective:
A life care planner must consider all life-long treatments required in a patient with posttraumatic torticollis, understanding the disorder often worsens and causes accelerated osteoarthritis of the cervical spine. The plan must include physical therapy evaluations, treatments, oral medications, Botox injections, psychological evaluations, physician treatments, and vocational training. The plan must include the possibility that occasional surgical intervention would be required. By providing a comprehensive plan, a patient will have optimal medical and psychosocial outcomes.
Attorney Perspective:
An attorney must prove past and future economic and noneconomic damages. Posttraumatic torticollis is a tragic disorder that deeply affects the client and everyone near and dear to the client. It may result from both major and what appeared to be mild injury. It is essential that an attorney understand and present recognized experts in the field to describe both the pathophysiology and the disability that results from this difficult to treat disorder. The expert must testify to the adequacy of the life care plan which will include medical costs that are reasonable and necessary in the management of a patient.
Media Information:
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