Posttraumatic painful torticollis

The development of abnormal posturing of the neck or shoulder after local injury has been termed posttraumatic cervical dystonia (PTCD). Certain features seem to distinguish a unique subgroup of patients with this disorder from those with features more akin to typical idiopathic cervical dystonia, such as onset and maximum disability that occurs very quickly after injury, severe pain and a fixed abnormal posture. In an attempt to clarify the nature of this syndrome further, we evaluated 16 such patients (8 men, 8 women). Motor vehicle accident and work‐related injuries were common precipitants, with posturing usually developing shortly after trauma, and little progression occurring after the first week. A characteristic, painful, fixed head tilt and shoulder elevation were present in all but one patient, who had a painless elevated shoulder and painful contralateral shoulder depression, as well as nondermatomal sensory loss in 14 patients. Additional abnormalities included dystonic posturing in a limb (2 patients) or jaw (1 patient), limb tremor (3 patients) and “give‐way” limb weakness (8 patients). The tremor and the jaw dystonia demonstrated features suggestive of a psychogenic movement disorder, most commonly distractibility. Litigation or compensation was present in all 16 patients. Intravenous sodium amytal improved the posture, pain or both in 13 of 13 patients; in 7 of 13 the sensory deficit either markedly improved or normalized. General anesthesia demonstrated full range of motion in all 5 patients assessed. Psychological evaluations suggested that psychological conflict, stress, or both were being expressed via somatic channels in 11 of 12 tested patients. Our results suggest an important role of psychological factors in the etiology or maintenance of abnormal posture, pain and associated disability of these patients. The role of central factors triggered in psychologically vulnerable individuals after physical trauma is discussed. We propose that the disorder be referred to as “posttraumatic painful torticollis” rather than characterize it as a form of dystonia until further information on its pathogenesis is forthcoming. © 2003 Movement Disorder Society

[1]  C. L. Kwan,et al.  Altered central somatosensory processing in chronic pain patients with “hysterical” anesthesia , 2003, Neurology.

[2]  A. Lang,et al.  Psychiatric outcome in patients with a psychogenic movement disorder: a prospective study. , 2001, Neuropsychiatry, neuropsychology, and behavioral neurology.

[3]  H. Middelkoop,et al.  Clinical aspects of multifocal or generalized tonic dystonia in reflex sympathetic dystrophy , 2001, Neurology.

[4]  P. Vuilleumier,et al.  Functional neuroanatomical correlates of hysterical sensorimotor loss. , 2001, Brain : a journal of neurology.

[5]  A. Mailis,et al.  Unexplainable nondermatomal somatosensory deficits in patients with chronic nonmalignant pain in the context of litigation/compensation: a role for involvement of central factors? , 2001, The Journal of rheumatology.

[6]  W. Weiner.  Can peripheral trauma induce dystonia? No! , 2001, Movement disorders : official journal of the Movement Disorder Society.

[7]  J. Jankovic.  Can peripheral trauma induce dystonia and other movement disorders? Yes! , 2001, Movement disorders : official journal of the Movement Disorder Society.

[8]  J. Ahlskog,et al.  Focal shoulder‐elevation dystonia , 2000, Movement disorders : official journal of the Movement Disorder Society.

[9]  Sean A Spence,et al.  Discrete neurophysiological correlates in prefrontal cortex during hysterical and feigned disorder of movement , 2000, The Lancet.

[10]  Richard S. J. Frackowiak,et al.  Imaging hypnotic paralysis: implications for conversion hysteria , 2000, The Lancet.

[11]  R. Verdugo,et al.  Abnormal movements in complex regional pain syndrome: Assessment of their nature , 2000, Muscle & nerve.

[12]  H L Rosomoff,et al.  Chronic pain disability exaggeration/malingering and submaximal effort research. , 1999, The Clinical journal of pain.

[13]  A. Samii,et al.  Post-traumatic Cervical Dystonia: A Distinct Entity? , 1999, Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques.

[14]  C. Marsden,et al.  Atypical and typical cranial dystonia following dental procedures , 1999, Movement disorders : official journal of the Movement Disorder Society.

[15]  L. Jamner,et al.  Repressive/defensive coping, endogenous opioids and health: how a life so perfect can make you sick , 1999, Psychiatry Research.

[16]  J. Jankovic,et al.  Peripherally induced oromandibular dystonia , 1998, Journal of neurology, neurosurgery, and psychiatry.

[17]  G. Kullgren,et al.  Motor conversion disorder. A prospective 2- to 5-year follow-up study. , 1998, Psychosomatics.

[18]  B. Ford,et al.  Post-traumatic shoulder 'dystonia': Persistent abnormal postures of the shoulder after minor trauma , 1998, Neurology.

[19]  D. Tarsy.  Comparison of acute‐ and delayed‐onset posttraumatic cervical dystonia , 1998, Movement disorders : official journal of the Movement Disorder Society.

[20]  C. Marsden,et al.  Slater revisited: 6 year follow up study of patients with medically unexplained motor symptoms , 1998, BMJ.

[21]  Gereon R Fink,et al.  The functional anatomy of a hysterical paralysis , 1997, Cognition.

[22]  E. Clark.  Conceptual perspective and lexical choice in acquisition , 1997, Cognition.

[23]  P. Ashby,et al.  Effect of intravenous sodium amytal on cutaneous limb temperatures and sympathetic skin responses in normal subjects and pain patients with and without Complex Regional Pain Syndromes (type I and II). I , 1997, Pain.

[24]  A. Mailis,et al.  Effect of intravenous sodium amytal on cutaneous sensory abnormalities, spontaneous pain and algometric pain pressure thresholds in neuropathic pain patients: a placebo-controlled study. II , 1997, Pain.

[25]  J. Krauss,et al.  Post-traumatic movement disorders in survivors of severe head injury , 1996, Neurology.

[26]  M. Trimble,et al.  Ten-Year Prognosis of Conversion Disorder , 1996, British Journal of Psychiatry.

[27]  A. Lang.  Psychogenic Dystonia: a Review of 18 Cases , 1995, Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques.

[28]  D. Fishbain,et al.  Secondary Gain Concept: A Review of the Scientific Evidence , 1995, The Clinical journal of pain.

[29]  Juhani Partanen,et al.  Altered cerebral blood flow during hysterical paresthesia , 1995, Biological Psychiatry.

[30]  C D Marsden,et al.  Dystonia after head trauma , 1994, Neurology.

[31]  C. Marsden,et al.  The behavioural and motor consequences of focal lesions of the basal ganglia in man. , 1994, Brain : a journal of neurology.

[32]  D. Maraganore,et al.  Posttraumatic cervical dystonia manifesting as isolated spasm of the middle scalene muscle. , 1994, Mayo Clinic proceedings.

[33]  C D Marsden,et al.  The causalgia-dystonia syndrome. , 1993, Brain : a journal of neurology.

[34]  S. Goldman,et al.  Posttraumatic cervical dystonia. , 1993, Mayo Clinic proceedings.

[35]  C. Marsden,et al.  Psychological functioning before and after treatment of torticollis with botulinum toxin. , 1992, Journal of neurology, neurosurgery, and psychiatry.

[36]  Michael Dunn.  Post-Polio Syndrome , 1991 .

[37]  C. Marsden,et al.  The relationship between trauma and idiopathic torsion dystonia. , 1991, Journal of neurology, neurosurgery, and psychiatry.

[38]  D. Fishbain,et al.  Chronic pain patients and the nonorganic physical sign of nondermatomal sensory abnormalities (NDSA). , 1991, Psychosomatics.

[39]  R. Schwartzman,et al.  The movement disorder of reflex sympathetic dystrophy , 1990, Neurology.

[40]  J. Jankovic,et al.  Dystonia and tremor induced by peripheral trauma: predisposing factors. , 1988, Journal of neurology, neurosurgery, and psychiatry.

[41]  A. Mailis,et al.  Use of sodium amytal interview in the assessment of complex chronic pain patients , 1987, Pain.

[42]  G. Schott.  The relationship of peripheral trauma and pain to dystonia. , 1985, Journal of neurology, neurosurgery, and psychiatry.

[43]  C. Marsden,et al.  The anatomical basis of symptomatic hemidystonia. , 1985, Brain : a journal of neurology.

[44]  C. Marsden,et al.  Muscle spasms associated with Sudeck's atrophy after injury. , 1984, British medical journal.

[45]  C. Carlson.  Assessment of chronic pain patients with the MMPI-2. , 1997 .

[46]  S. Fahn,et al.  Phenomenology and psychopathology related to psychogenic movement disorders. , 1995, Advances in neurology.

[47]  M. Hegel,et al.  Assessment of chronic pain patients with the MMPI-2 , 1993 .

[48]  C. Marsden,et al.  A case‐control study of idiopathic torsion dystonia , 1991, Movement disorders : official journal of the Movement Disorder Society.

[49]  D. D. Truong,et al.  Posttraumatic torticollis. , 1991, Archives of neurology.