The treatment consists in ensuring free action of the bowels and kidneys, in inducing hyperæmia by means of heat, and applying gentle massage. Salicylates and similar drugs are useful in relieving the pain.
Permanent or true wry-neck is due to an organic shortening of the sterno-mastoid muscle. The trapezius, the splenius, the scaleni, and the levator scapulæ muscle may also undergo shortening, along with their investing sheaths derived from the cervical fascia.
The sternal head of the sterno-mastoid is always markedly shortened, and stands out as a tight cord; sometimes the clavicular head is also prominent.
There is evidence that in the majority of cases the deformity results from some interference with the development of the muscles during intra-uterine life. This is probably the effect of undue pressure on the fœtus diminishing the arterial supply to the central part of the muscle, with the result that the muscle fibres undergo degeneration with subsequent sclerosis and contraction. It may result also from cicatricial contraction of the muscle following rupture of its fibres during delivery. In such cases there is a history that the birth was a difficult one, the presentation having been abnormal; and that a swelling was observed in the sterno-mastoid shortly after birth. This swelling—a hæmatoma of the sterno-mastoid—is at first soft, later becomes smaller, and eventually disappears. In course of time, sometimes months, sometimes years after the disappearance of the swelling, shortening of the muscle takes place, and the deformity is established.
Clinical Features.—Although the condition is usually described as “congenital,” it is the common experience in practice that the child has reached the age of from seven to ten years before advice is sought. The appearance of the patient is characteristic ([Fig. 271]). The shortening of the sterno-mastoid pulls the head towards the affected side, usually the right, so that the ear is approximated to the shoulder. At the same time the head is rotated towards the opposite side and slightly tilted backwards, with the result that the chin is directed towards the opposite side, and is somewhat raised. The shortened sterno-mastoid stands out prominently, and, on any attempt to straighten the head, can be felt as a firm, fibrous band. The skin of the affected side of the neck may be thrown into transverse folds. The patient is unable to correct the deformity, but it is usually possible to diminish it by manipulation.
Fig. 271.—Congenital Wry-neck in a boy æt. 14.
If the condition is not corrected, all the structures on the affected side of the neck undergo organic shortening, with the result that the deformity becomes accentuated. In advanced cases a lateral curvature, with the convexity towards the normal side, occurs in the cervical region, the vertebræ becoming wedge-shaped from side to side, and a compensatory curve may develop in the thoracic region ([Fig. 272]).