10 y F p/w right neck pain starting last night, she has decreased ROM with her head tilted to the left.
This child has atlanto-axial subluxation, sometimes called Grisel syndrome. The key to identifying this condition and differentiating it from torticollis caused by muscle spasm is the relationship between head position and side of pain. As opposed to torticollis due to spasm of SCM or trapezius, in atlanto-axial subluxation, the head is tilted away from the side of pain and SCM tenderness, and the chin points towards the painful side.
Diagnosis is made with plain radiographs or CT, treatment may be conservative with collar and pain control or may be surgical, depending on the degree of subluxation.