Introduction

Torticollis, known widely as a wry neck, is an abnormal asymmetrical head or neck position that usually happens because the sternocleidomastoid muscle on one side is shortened or tightened. It is congenital, but there is acquired torticollis, which can occur as a result of some trauma, infection, or as a result of some disease.¹ Knowledge of the epidemiology of torticollis is of absolute importance, to recognise at-risk populations and to detect and set up successful preventive and curative measures. Despite that, a study of incidence and demographic factors is needed to identify the depth of this condition and formulate the intervention based on the affected people’s needs.

Incidence of torticollis

The incidence of torticollis depends on the type of study and the population studied. Although, congenital torticollis is estimated to be approximately 0.3% to 2%, variations are reported in rates as diagnostic criteria and access to healthcare services vary across regions.² Less is published about the adult version of acquired torticollis, but it is thought to occur more commonly in adults whose occupations or lifestyles strain neck muscles.

Regional differences also influence torticollis. The rates of congenital torticollis are often commonly reported by high-income countries, probably because of better diagnostic capabilities and healthcare infrastructure. On the other hand, governments of low-income countries may underreport cases if they do not have medical resources.^1,3 Also, cities which have more advanced healthcare systems have more instances of torticollis than that of rural areas of the world where healthcare is unavailable.

Although, prenatal and perinatal care have decreased some of these risk factors such as birth trauma, congenital torticollis incidence has not fallen significantly over time. However, cases of acquired torticollis have grown in line with increased sedentary habits and bad posture, not to mention in adults.

Demographic factors associated with torticollis

Torticollis affects all demographic groups, including age, gender, ethnicity, or socioeconomic status of the person. There is no incidence of reduced thyrocervicalis muscle innervation and it has no impact on the outcome.

Age

In general, infants are diagnosed with congenital torticollis during their first few months. Early intervention is key, and physical therapy will largely improve outcomes and reduce long-term problems.³ Torticollis can be acquired at any age. However, it is more frequent in adults as it can be related to traumatic, infectious, or degenerative conditions.

Gender

Studies have shown that congenital torticollis is slightly stronger such that the man-woman ratio favours the former.³ The cause behind this disparity is unclear. The reasons may be hormonal or genetic. Compared to acquired torticollis, the gender difference is not that prominent, although some causes of this condition, like sports injuries, are more evident in males.

Ethnicity and race

Torticollis' incidence may differ from ethnic group to ethnic group. For instance, the rate of congenital torticollis is said to be higher in the Asian population than in the Caucasian and African populations.^1,3 However, genetics or cultural practices may influence how an infant lies down, but they may not, such as in swaddling techniques, which could influence an infant’s position.

Socioeconomic status

The epidemiology of torticollis is also influenced by socioeconomic factors.⁴ People from lower socioeconomic backgrounds may be delayed from the time the doctor perceives the problem and decides to refer them, to the time they finally get a diagnosis and treatment. These differences might affect the care for people with torticollis to change in the short term and have consequences in the long term.

Risk factors for torticollis

Risk factors for developing torticollis comes from several causes, depending on whether or not they are congenital or acquired in form.

Congenital torticollis

Torticollis is a congenital condition resulting from birth trauma such as breech delivery, forceps, or vacuum extraction in childbirth. All of these factors can cause muscle injury or shortening, which causes the head tilt characteristic of this condition.^1,3 In addition, the extended abnormal positioning of the foetus in the womb may also cause the development of torticollis.

Acquired torticollis

Acquired torticollis develops as a result of trauma or other neck injuries such as accidents, falls, or sports activities. Infections in the upper respiratory tract and infection in the cervical spine, can also cause torticollis, literally referred to as a sun-turned sideways position, when an individual twists to one side and contracts the muscle in the neck.^5,6 An individual is more predisposed to have this condition when having underlying medical conditions like cervical spine abnormalities, tumours, or neurological disorders.⁶ Torticollis might be acquired due to reasons such as inappropriate posture, constantly repeating neck movements, and constantly using electronic devices that put stress on the muscles of the neck, and consequently, this leads to torticollis.

Impact of torticollis on public health

Torticollis is a high burden on the public health system because it continues to affect individuals, their families, and most importantly the communities.

Burden on healthcare systems

Although torticollis requires significant healthcare resource expenditures in terms of diagnostic imaging, physical therapy, and rarely in surgery, the diagnosis and treatment of the condition also requires significant resources.^1,6,7 These demands are challenging to manage in poor resource settings because, they place a lot of pressure on health systems.

Long-term outcomes and complications

If the torticollis is not treated, then it can lead to a permanent physical disability such as chronic neck pain, limited range of motion, or deformities.^8,9 Low self-esteem, stigma, psychological torture, and even depression are also highly likely.

Economic costs

Torticollis has a high proportion of direct and indirect costs.⁷ Direct medical expenses include diagnosis, treatment, and rehabilitation of the disease, and indirect costs comes from low productivity or absenteeism from work or school.

Prevention and early intervention

Prevention and early intervention are important to minimise the consequences of torticollis on subjects and the health system.^1,2,3,4

Importance of early diagnosis and treatment

Treatment of congenital torticollis is needed specifically, as early detection and treatment limit long-term problems and improve outcomes.¹ However, in the worst cases, surgery may be required sometimes.

Public health strategies

The prevention of congenital torticollis requires public health intervention in prenatal and perinatal care.¹⁰ In awareness campaigns, parents and caregivers will be taught about  the awareness of early signs so that treatment can be initiated earlier.

Role of physical therapy and rehabilitation

Physical therapy is used to treat torticollis to prevent complications and regain a normal neck function. Everyone, regardless of socioeconomic status should have access to available rehabilitation programs.

Conclusion

Torticollis has varying incidence and demographic influence. Congenital torticollis is more common in infants and males are more prone to it, along with those of adult age who have the acquired form of it. Regional, ethnic, and socioeconomic factors also contribute to the epidemiology of the condition.

The knowledge of epidemiology is crucial for the development of prevention and treatment strategies for torticollis. For public health policies to be effective, access to healthcare, early intervention, as well as awareness of the condition, should be improved at the very beginning. These issues can reduce the burden of torticollis and improve the quality of life of the patients if healthcare providers, policymakers, as well as the public, take the initiative.

Summary

Torticollis or 'wry neck' refers to an abnormal neck position that appears twisted, resulting from contraction or shortening of the sternocleidomastoid muscle (SCM). Torticollis comes in two versions, congenital, meaning that it appears during birth, and the other acquired, which means that it develops later due to trauma, an infection, or a disease. It allows an understanding of its epidemiology and provides evidence enabling early diagnosis and treatment for at-risk populations.

• Incidence rates: the prevalence of congenital torticollis is higher in males, especially the percent of live births and higher in high-income countries. Occupational strain is a more commonly acquired torticollis, where the adult will usually have that condition.
• Demographic factors: prevalence is affected by age, gender, ethnicity, socioeconomic status, and some other risk factors. The majority of cases of congenital torticollis affect males, while acquired torticollis occurs at an equal rate in males and females. There is a disparity by ethnic and socioeconomic status in the diagnosis and treatment outcome.
• Risk factors: birth trauma or intrauterine positioning is usually the cause of torticollis but, it can also be an acquired disease through trauma, infection, or bad lifestyle (poor posture).
• Public health impact & prevention: This is a condition that places a great burden on healthcare involving long-term consequences. To discourage the impact of this illness, it boils down to early intervention, prenatal care, physical therapy, and equal healthcare access. This can help bring more awareness and research of this disease to better prevent and treat it, so more patients can have a better outcome.