5 Minute Physio tip - Acute wry neck diagnosis & treatment

Acute wry neck diagnosis and treatment

How you can differentiate acute wry neck from discogenic wry neck, and why is it important to identify which type of wry neck your patient is presenting with?

Acute and discogenic wry neck will have a very different presentation and patient population, and different prognosis and the treatment. Find out how to identify and differentiate acute wry neck in this week's 5 minute Physio tip.

What is wry neck?

Patients with wry neck will have both neck pain and restriction of movement, and symptoms will be unilateral or asymmetrical.

What are the types of wry neck?

• Acute wry neck
• “Discy” wry neck
• Atlanto-Axial subluxation
• Spasmodic torticollis (Cervical Dystonia)
• Hysterical wry neck

The presentation of acute wry neck will be in pre-teens to young adults, with a higher incidence of females than males. There is a sudden onset of pain following a trivial incident or post viral, and patients are often painfree at rest.

What are the local tissue causes of wry neck?

The causes are really unknown, but may include:

• Entrapped fat pad
• Entrapped/extrapped menisci
• Acute nipping of synovial fringe of capsule

Objective findings in acute wry neck

Patients with an acute wry neck should be able to find a comfortable position. When active movement testing is performed, they are unable to rotate or laterally flex to contralateral side, and unable to reach midline with rotation or LF. They will also often have sharp, sudden pain with active movements.

Prognosis and treatment

Prognosis for acute wry neck is excellent, as this condition is self-limiting, however it often recurs. Patients generally respond quickly to treatment, with shorter recovery time than discogenic wry neck.

Successful treatment should involve the use of rotation, lateral flexion movements or PPIVM’s in a painfree direction. PAIVM’s or manipulation should not be your first line treatment.

Following treatment, you should expect nearly full range of movement to result, or at the very least your patient should have no sharp pain.

Differentiation

It is important to differentiate acute wry neck from atlantoaxial subluxation, which will be covered in another article.

Links

Discogenic wry neck diagnosis & treatment is covered in the next 5 minute Physio tip video