Diagnostic Tests for Torticollis
Torticollis Tests: Book Excerpts
Torticollis Diagnosis: Book Excerpts
Diagnostic Tests for Torticollis: Online Medical Books
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Dystonia:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
If possible, include the patient’s family in history taking; they may be more aware of behavior changes than the patient is. Begin by asking them when dystonia occurs. Is it aggravated by emotional upset? Does it disappear during sleep? Is there a family history of dystonia? Obtain a drug history, noting especially the use of a phenothiazine or an antipsychotic. Dystonia is a common adverse effect of these drugs, and the dosage may need to be adjusted to minimize this effect.
Next, examine the patient’s coordination and voluntary muscle movement. Observe his gait as he walks across the room; then have him squeeze your fingers to assess muscle strength. (See Recognizing dystonia.) Check coordination by having him touch your fingertip and then his nose repeatedly. Follow this by testing gross motor movement of the leg: Have him place his heel on one knee, slide it down his shin to the top of his great toe, and then return it to his knee. Finally, assess fine-motor movement by asking him to touch each finger to his thumb in succession.
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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Stiff Neck and Torticollis:
Diagnostic Approach
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
Useful distinctionis whether neck stiffness or torticollis is congenital or acquired. Congenitalmuscular torticollis can usually be diagnosed by physical exam.Cervical spine radiography can diagnose skeletal spine anomaliesand atlantoaxial instability.Most common acquired causes of neckstiffness or torticollis are muscle strain, other musculoskeletaltrauma, pharyngitis, tonsillitis, cervical adenitis, viral myositis,and meningitis.With history of trauma, cervical spineradiography should be performed.Presence of fever usually signifiesinfection.Lumbar puncture should be performedwith suspected meningitis.Fever and localized tenderness of cervicalspine suggests cervical osteomyelitis, and cervical spine radiographyand bone scintigraphy are often helpful.History and physical exam should suggestpresence of other causes of neck stiffness and torticollis.CT is initial procedure of choice forsuspected subarachnoid hemorrhage or primary brain tumor. This proceduremay be followed by MRI.
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Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
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Diagnosis of Torticollis
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