A treatise on orthopedic surgery . e themost prominent symptoms of disease of this region, one mustconsider first the forms of torticollis for which it might bo mis-taken. In typical torticollis the distortion of the head is causedalmost invariably by contraction of the muscles supplied in partby the spinal accessory nerve, the sternomastoid, and trajiezius,thus, the chin is slightly elevated and turned away from thecontracted muscle. Congenital torticollis, which has existed from birth, is notaccompanied by pain and it eon Id hardly be mistaken for asymptom of disease. TUBEBCULOUS DISEASE OF
A treatise on orthopedic surgery . e themost prominent symptoms of disease of this region, one mustconsider first the forms of torticollis for which it might bo mis-taken. In typical torticollis the distortion of the head is causedalmost invariably by contraction of the muscles supplied in partby the spinal accessory nerve, the sternomastoid, and trajiezius,thus, the chin is slightly elevated and turned away from thecontracted muscle. Congenital torticollis, which has existed from birth, is notaccompanied by pain and it eon Id hardly be mistaken for asymptom of disease. TUBEBCULOUS DISEASE OF THE SPINE. 61 Acute rheumatic torticollis, stiff neck, is a commonaffection. It is of sudden onset, in a single night; theaffected muscles are sensitive to pressure; the course of theaffection is short and it is of comparative insigTiificance. A more persistent form of acute torticollis, characterized bymuscular spasm and by local sensitiveness, sometimes accom-panies enlarged or suppurating cervical glands; it may follow Fig. Deformity at the cervical vertebra indicated by the vrrinkle in the neck. Theattitude of the head and the compensatory projection in the lumbar region arecharacteristic. ear-ache, tonsillitis, sore-throat, or any form of irri-tation about the pharynx. This form of wryneck is not onlyvery painful, but it may persist indefinitely, and permanentdeformity may result. The onset is usually sudden; the painand sensitiveness are local and are confined, as a rule, to thecontracted part. The sternomastoid and trapezius muscles aremost often involved; thus, the wryneck is typical. If the ten-sion be relaxed by inclining the head toward the contractedmuscles, motion of the spine itself will be found to be free andpainless; but if traction is made on the contracted muscles itcauses discomfort, and it is usually resisted by the patient. 62 OFiTHOPEDIC SUHGERY. lu disease of the occipitoaxoid region the distortion of thehead is by no means typical of sternomastoid
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