Professor Con Yiannikas
MUSCLE SELECTION
Torticaput
Cervical Dystonia
Muscle Selection
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Head rotated via C1-2 (Atlanto-axial joint)
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C3-7 vertebral column no movement
C3
C7
Torticollis
Cervical Dystonia
Muscle Selection
C3
C7
C3-6 rotate with C1-2 and head
Torticollis
Cervical Dystonia
Muscle Selection
Axial Rotation - Torti
Cervical Dystonia
Muscle Selection
Rotation of Head
Cervical Dystonia
Muscle Selection
- Attaching to skull
- Unilateral contraction
Anterolateral muscles contralateral rotation
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Trapezius
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SCM
Posterolateral muscles ipsilateral rotation
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Splenius capitus
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Longissimus capitus
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Splenius cervicus
Posteromedial contralateral rotation
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Semispinalis capitis
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Spinalis capitis
Torticaput
Cervical Dystonia
Muscle Selection
Muscles Attaching to Skull
- Ipsilateral rotation
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Splenius capitis
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Splenius cervicis
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Longissimus capitis
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Obliquis capitis inferior
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Levator Scapulae
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Contralateral rotation
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Trapezius
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Sternomastoid
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Semispinalis capitis
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Spinalis capitis
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Midline
Lateral
Torticollis
Cervical Dystonia
Muscle Selection
Muscles Attached to Spine
- Ipsilateral rotation
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Longissimus cervicis
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-
Contralateral rotation
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Semispinalis cervicis
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Scalenus anterior
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Retrocaput
Cervical Dystonia
Muscle Selection
Retrocollis
Cervical Dystonia
Muscle Selection
Motion in Saggital Plane
Cervical Dystonia
Muscle Selection
Retro
Extension
Cervical Dystonia
Muscle Selection
- Posterior and posterolateral muscles acting together
Retrocaput
Cervical Dystonia
Muscle Selection
Muscles Attached to Skull
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Trapezius
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Sternomastoid
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Splenius capitis
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Splenius cervicus
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Semispinalis capitis
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Spinalis capitis
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Longissimus capitis
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Obliquus capitus inferior
Range of Motion
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13 Degrees
Retrocollis
Cervical Dystonia
Muscle Selection
Muscles Attached to Spine
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Midline
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Semispinalis cervicis
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Longissimus cervicis
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-
Range of Motion
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8 Degrees
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Anterocollis
Cervical Dystonia
Muscle Selection
Anterocaput
Cervical Dystonia
Muscle Selection
Motion in Saggital Plane
Cervical Dystonia
Muscle Selection
Antero
Flexion
Cervical Dystonia
Muscle Selection
- Anterior muscles acting together
Anterocaput
Cervical Dystonia
Muscle Selection
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Insert base of skull or jaw
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Longus Capitis
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Platysma
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Digastric/submental
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Anterocollis
Cervical Dystonia
Muscle Selection
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Insert spine
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Scalenus medius and anterior
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Longus Colli
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- SCM
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Extends head and flexes spine
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Laterocollis
Cervical Dystonia
Muscle Selection
Larynx shifted relative to sternum
Laterocaput
Cervical Dystonia
Muscle Selection
Movement in the Coronal Plane
Cervical Dystonia
Muscle Selection
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Majority of patients (60%) have lateral flexion of head and neck in varying proportions.
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20% head only, 20% neck only
Lateral Flexion
Cervical Dystonia
Muscle Selection
- Lateral muscles acting in isolation
Laterocaput
Cervical Dystonia
Muscle Selection
Muscles Attached to Skull
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Trapezius
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Sternomastoid
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Splenius capitis
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Splenius cervicus
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Levator scapulae
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Longissimus capitis
Range of Motion
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8 Degrees
Laterocollis
Cervical Dystonia
Muscle Selection
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Long muscles transversing spine
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Levator scapulae
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Scalenus Anterior/medius
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Semispinalis cervicis
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Longissimus cervicis
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Biomechanical advantage
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Range - 37 degrees
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Lateral Shift
Cervical Dystonia
Muscle Selection
Secondary to lateral flexion of the spine and flexion of the head in the opposite direction.
Lateral Shift
Cervical Dystonia
Muscle Selection
Lateral Shift
Cervical Dystonia
Muscle Selection
Lateral Shift
Cervical Dystonia
Muscle Selection
Saggital Shift - Protraction
Cervical Dystonia
Muscle Selection
- Due to a combination of extension of head and flexion of neck
- Often due to bilateral tonic contraction of Sternomastoid
Saggital Shift - Retraction
Cervical Dystonia
Muscle Selection
- Due to a combination of neck extension and head flexion
- Produces “double chin” look
Lateral and Saggital Shift
Cervical Dystonia
Muscle Selection