A treatise on orthopedic surgery . affection is of short duration; in othersparticularly those in which the reflex spasm is aggravated bylocal inflammatory processes, there appears to be but little ten-dency toward recovery. In such cases, after several weeks ormonths, the local pain and sensitiveness may subside, togetherwith the active spasm, but the deformity, caused by adaptiveshortening of the muscles and fascia, aggravated in some in-stances by actual myositis, persists. The muscles atrophy and 680 OETHOPEDIC SUBGEEY. degenerate and j)resent at a later stage the same pathologicalappearan
A treatise on orthopedic surgery . affection is of short duration; in othersparticularly those in which the reflex spasm is aggravated bylocal inflammatory processes, there appears to be but little ten-dency toward recovery. In such cases, after several weeks ormonths, the local pain and sensitiveness may subside, togetherwith the active spasm, but the deformity, caused by adaptiveshortening of the muscles and fascia, aggravated in some in-stances by actual myositis, persists. The muscles atrophy and 680 OETHOPEDIC SUBGEEY. degenerate and j)resent at a later stage the same pathologicalappearances that are fonnd in the congenital form. Diagnosis.—Torticollis is most often confounded with Pottsdisease and in its acute form there may be some difficulty indistinguishing between the two. The main points have beenmentioned already in connection with Potts disease. In acutetorticollis the affection is of sudden onset, not j)ieceded by thestiffness and neuralgic pain that characterize tuberculous disease. Fig. 439. Fig. Bilateral contraction of thesternomastoid and trapezii mus-cles. (See Fig. 440.) Bilateral torticollis after treatment.(See Fig. 439.) The deformity of torticollis is almost always of the regular type—that is, the head is tilted toward the contracted muscles whilethe chin is rotated in the opposite direction. The spasm andcontraction of the aifected muscles are apparent, and directtension upon them is painful. If, however, the tension is re-laxed by inclining the head toward the contraction, movementof the head in other directions will be found to be practicallyunrestricted. In Potts disease the spasm of muscles is general, the de-formity is not of a regailar type, since the chin often points tothe side toward which the head is inclined. Steady tension with CONGENITAL AND ACQUIBED TORTICOLLIS. 681 the aim of reducing the deformity is not, as a rule, painful; infact, it is often agreeable to the patient. Finally, the limitationof motion cannot be le
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