Wryneck – a disease at which the ducking with its simultaneous turn to the opposite side is observed. Arises owing to pathological changes of bones, nerves and soft tissues of a neck. Can be congenital or acquired. The congenital wryneck is a pre-natal malformation, acquired can develop owing to pathological childbirth, injuries, infectious diseases and diseases of nervous system. Deformations of a skull and a backbone, neurologic violations, violations of intellectual development, decrease in memory and attention and deterioration in function of breath can turn out to be consequence of a wryneck. The diagnosis is exposed on the basis of yielded survey, results of a X-ray analysis and other researches. Medical tactics depends on the wryneck reason. Perhaps both conservative, and expeditious treatment.
Wryneck – the pathological state which is followed by a ducking with its simultaneous turn in other party. Is widespread pathology of newborns, however can meet also at advanced age. Includes group of diseases with similar symptomatology. Defeat of one or several anatomical structures of a neck becomes the reason of a wryneck, most often this state arises at pathological changes in area - a clavicular and mastoidal muscle. Depending on the reason of development of a disease by treatment of a wryneck children's orthopedists, children's surgeons, infectiologists, neurologists and other experts can be engaged.
The congenital wryneck is formed in the pre-natal period. The wrong provision of a fruit, the wrong structure of a basin of mother, infectious diseases, some hereditary diseases and chromosomal mutations can be the cause of development. Is congenital anomaly of bone and muscular system, the third on prevalence, after a clubfoot and congenital dislocation of a hip. Girls suffer more often than boys.
The idiopathic wryneck – comes to light an insignificant unstable ducking. The reasons of formation are unknown, however is established that pathology arises at the complicated childbirth and pathological pregnancy more often. At a palpation is defined - the clavicular and mastoidal muscle of normal length and a form which is in a condition of excessive tension. At children with an idiopathic wryneck often segmentary insufficiency of cervical department of a backbone and perinatal encephalopathy also comes to light.
Miogenny wryneck – the most common form of a wryneck. Develops as a result of consolidation and shortening - a clavicular and mastoidal muscle. The congenital muscular wryneck can be early and late. Early comes to light at the birth, late – at the age of 3-4 weeks. The cross provision or pelvic diligence of a fruit at which the child's head a long time remains inclined to a shoulder can become the reason of development – such situation causes decrease in elasticity and fibrosis of a muscle. At survey the head of the child is inclined towards the affected muscle and developed to the opposite side.
At a palpation uniform consolidation of muscular tissue or local consolidation of rounded shape on border of an average and lower third of a muscle comes to light. Attempts of passive movements are painful. The Nelechenny miogenny wryneck is the reason of a curvature of a backbone, violation of development of a skull and area of a humeral belt. The child's face becomes asymmetric, bones from defeat are flattened, the ear, an eyebrow and an eye fall in comparison with a healthy half. The bilateral miogenny wryneck which is followed by a ducking to a breast and sharp restriction of movements is sometimes observed.
The osteogene wryneck (Klippelya-Feyl's disease) develops at congenital pathology of cervical vertebras. Reduction of the size and/or a shape of vertebras or their union in the uniform block is possible. At survey shortening and deformation of a neck comes to light; the head which is pulled in in shoulders quite often turned aside; restriction of mobility of a neck; decrease in the line of growth of hair on a nape. The curvature of a neck is quite often combined with other anomalies of development of a skeleton. The osteogene wryneck in itself, as a rule, does not cause pains, however can become the reason of development of radiculitises of cervical department of a backbone.
The neurogenetic wryneck arises owing to a dystonic syndrome at which increase in a tone of muscles in one half of a body at decrease is observed in another. Pathology is followed by similar violations in a trunk and extremities: the leg on the party of defeat is bent, the handle is bent and compressed in a fist, the trunk is bent. The active and passive movements in a neck are kept, however at rest the head of the child "goes" to vicious situation.
The Artrogenny wryneck develops owing to a congenital rotational incomplete dislocation of the I cervical vertebra.
The acquired wryneck
The pathological childbirth which is followed obvitiy by an umbilical cord, ischemia or an injury of muscles of a neck can become the reason of development of the acquired wryneck. At advanced age the curvature of a neck can result from injuries, infectious diseases and diseases of nervous system. The most common and the most easily cured form of the acquired wryneck is the neck curvature as a result of a rotational incomplete dislocation of C1.
The adjusting wryneck – develops if the baby a long time is in the wrong situation in a bed. Pathological changes of bodies and fabrics are absent.
Compensatory and reflex wryneck. The reflex curvature of a neck can arise at purulent processes in a neck, a perikhondrita of edges, an inflammation of a mastoidal shoot (mastoidita) and a middle ear (otitis) – in such cases to reduce pain, the patient inclines the head aside. The compensatory wryneck can develop at squint and diseases of an inner ear (labirintita). In the first case the ducking allows to use better the available field of vision, in the second – to reduce dizziness. The movements in cervical department of a backbone at compensatory and reflex forms of a wryneck are kept in full.
The traumatic bone and articulate wryneck – arises sharply, the fracture of the I cervical vertebra is the reason. Is followed by sharp morbidity, restriction of movements in cervical department, pains at a palpation, development of pyramidal insufficiency and a bulbarny syndrome. One more kind of the acquired bone and articulate wryneck is the incomplete dislocation of C1 which can be formed at any age, but to a thicket comes to light at children. The sharp turn of the head in life or during sports activities becomes the reason of an incomplete dislocation.
Not traumatic (infectious) bone and articulate wryneck – can come to light at osteomyelitis, bone tuberculosis and tertiary syphilis. Fusion or pathological fractures of cervical vertebras is the reason of development.
Except the listed forms, allocate a wryneck at backbone tumors; a hysterical form of a disease which in some cases can come to light at hysterical psychosis; the dermatogenny wryneck arising at rough hems on skin; the desmogenny curvature of a neck which is formed as a result of an inflammation and cicatricial regeneration of fabrics (muscles, ligaments, cellulose, lymph nodes); the miogenny wryneck which is formed after an inflammation of muscles of a neck (miozit) and a neurogenetic form of a disease which can develop at cerebral palsy or to become an outcome of the postponed neuroinfection.
The diagnosis of a congenital wryneck is established on the basis of the anamnesis, yielded survey and results of a X-ray analysis of cervical department of a backbone. At inspection of the baby the doctor finds out what were childbirth – normal or pathological whether there were problems during pregnancy when parents noticed a neck curvature – from the first days of life or through a certain period of time etc. For an exception of violations from nervous system appoint survey of the neuropathologist. If necessary to estimate a condition of myagkotkanny structures of a neck of the child direct to MRT.
The list of diagnostic techniques at suspicion on the acquired wryneck depends on the anamnesis and the nature of pathology. The radiological research is in the obligatory plan of inspection, at the same time can be appointed both a X-ray analysis of cervical department, and a X-ray analysis of the first or second of cervical vertebras. At squint consultation of the ophthalmologist is shown, at suspicion of tuberculosis – consultation of the phthisiatrician, at suspicion of syphilis – consultation of the venereologist, at a hysterical form – consultation of the psychiatrist.
treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!
Treatment of a congenital miogenny wryneck can be both conservative, and quick. At early stages the electrophoresis with lidazy and iodide of potassium, UVCh, the special correcting exercises and massage is applied. In most cases full elimination of pathology requires 5-6 months. At inefficiency of conservative therapy carry out surgery, crossing heads - a clavicular and mastoidal muscle. If shortening of the affected muscle makes 40 and more percent on comparison with the healthy party, carry out plasticity. In the postoperative period impose plaster which in a month is replaced with Shants's collar. At the acquired muscular wryneck similar medical techniques are used.
At a congenital neurogenetic wryneck apply medicamentous therapy, physiotreatment, LFK and massage. At the neck curvature which resulted from a neuroinfection appoint antibiotics, miorelaksant and anticonvulsive medicine. After subsiding of an inflammation to the patient recommend to carry Shants's collar and direct to LFK. In hard cases carry out surgical correction.
At a congenital osteogene wryneck (Klippelya-Feyl's disease) appoint LFK and massage. For reduction of cosmetic defect sometimes delete highly located top edges. At the traumatic curvature of a neck which developed as a result of a change apply extension by Gleason's loop and plaster bandages, in case of need perform surgeries. At a wryneck owing to an incomplete dislocation of C1 perform the closed reposition with use of a loop of Gleason and impose Shants's collar. In the remote period after a trauma in the presence of organic changes in a backbone, a neck and a humeral belt appoint electropulse therapy, an electrophoresis, massage and LFK.
Desmogenny and dermatogenny wrynecks eliminate in the operational way, excising cicatricial fabrics and carrying out plasticity auto-, hallo - or ksenotransplantatam. At tumors and infectious damage of bones perform treatment of the main pathology, and in the subsequent carry out recovery operations.
The forecast depends on the reasons of development and duration of existence of pathology. The majority of the congenital and acquired wryneck forms at early adequate treatment well give in to correction. An exception – Klippelya-Feyl's disease at which the expressed restriction of movements remains. The Nelechenny curvature of a neck can become a cause of infringement of development of the child, formation of rough cosmetic defects and the subsequent disability. Vicious position of a neck leads to dystrophic regeneration of muscles, interferes with normal development of a skull and causes the progressing asymmetry of the person.
Excessive pressure upon the neck vessels delivering blood to a brain becomes the reason of migrenepodobny headaches in the beginning, and then – and violations of brain functions. At children intellectual development suffers. At adults the attention and memory worsens. Because of change of position of a trachea functions of external breath decrease, at the congenital pathology and a wryneck which arose at early age lag of growth of a thorax on the party of defeat is possible. Often otitises and sinusitis develop, hearing worsens, squint is formed.