TAILIEUCHUNG - Ebook Textbook of orthopedics (4/E): Part 2
Part 2 book “Textbook of orthopedics” has contents: Regional conditions of the neck, regional conditions of the neck, congenital disorders, developmental disorders, metabolic disorders, skeletal tuberculosis, rheumatic diseases, neuromuscular disorders, distal forearm fractures, fracture neck of femur, and other contents. | 29 • • • • Regional Conditions of the Neck Torticollis (Wryneck) Thoracic outlet syndrome Cervical rib Cervical disk syndromes Regional orthopedics deals with a vast array of interesting orthopedic problems. Each region has its own peculiar problems depending on various factors like anatomical, physiological, occupational and others operating in that region. An effort is made in this section to highlight the various regional orthopedic problems. However, a detailed description of the regional disorders is avoided as it is outside the scope of this book. The student is requested to refer bigger books in orthopedics in case he or she desires a detailed study of the regional problems. TORTICOLLIS (WRYNECK) Torticollis is defined as the rotational deformity of cervical spine that causes turning and tilting deformity of the head and neck (Fig. ). • Unilateral muscle paralysis, . polio. • Neuritis of spinal accessory nerve. • Ocular disturbances: Child turns head to one side to compensate for defective vision. Clinical Features Head of the patient is tilted towards the affected side while the chin points to the other side. Sternocleidomastoid muscle is prominently seen. In the later stages, the patient may develop facial asymmetry and macular disturbances in the eye. Among the acquired causes of torticollis, spasmodic muscle contraction of the sternocleidomastoid is the most common cause. Management Conservative Initially conservative line of treatment is observed. This consists of nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants drugs, etc. Causes • Congenital: (See Chapter 35, Congenital Disorders for description). • Infective: Tuberculosis of cervical spine, acute respiratory tract infection, etc. • Traumatic Sprain, dislocation and fracture of the cervical spine. • Myositis or fibromyositis of sternocleidomastoid, exposure to cold causes myositis. • Spasmodic: Painful, persistent or intermittent sternomastoid muscle contraction. Fig. :
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