This article has a correction

Please see: Emerg Med J 2005;22:758

Emerg Med J 22:646-649 doi:10.1136/emj.2004.015586
  • Short report

Not all cases of neck pain with/without torticollis are benign: unusual presentations in a paediatric accident and emergency department

  1. A Natarajan1,
  2. J G Yassa2,
  3. D P Burke2,
  4. J A Fernandes3
  1. 1Department of Child Health, Sheffield Children’s Hospital, Sheffield, UK
  2. 2Department of Accident and Emergency, Sheffield Children’s Hospital, Sheffield, UK
  3. 3Department of Paediatric Orthopaedics and Trauma Surgery, Sheffield Children’s Hospital, Sheffield, UK
  1. Correspondence to:
 A Natarajan
 Lecturer in Child Health, Sheffield Children’s Hospital, Sheffield, S10 2TH, UK;
  • Accepted 18 June 2004

Neck pain in children is not an uncommon presenting complaint in a paediatric accident and emergency department. Sheffield has a population of approximately 97 000 children of whom 33 874 attended the accident and emergency department at the children’s hospital in a one year period from 1998 to 1999. Of these, about 817 had pain in the neck region as part of their presenting complaint.

Neck pain in adults is often a manifestation of degenerative disease of the spine whereas in children the commonest causes are trauma and infections. There are other less common but more sinister underlying causes of neck pain. The aim of this paper is to highlight these unusual conditions which present as neck pain.

Most junior doctors term muscular spasm in the neck region as torticollis. Not all kinds of unusual neck posturing and pain, however, are due to torticollis and not all cases of torticollis are benign.1,2 This differentiation is important in the clinical work up of these patients.

We describe five patients who attended the accident and emergency department at our hospital with a presenting complaint of neck pain. These cases highlight the importance of careful evaluation of neck pain in children to prevent delay in diagnosis of less common but more serious underlying conditions. The clinical features in the history and/or examination which should raise suspicion of a less benign cause of the neck pain are highlighted with an asterix (*).


Patient 1

A 6 year old boy presented with neck pain of sudden onset and restricted neck movement. He was unable to localise the exact site of the pain. There was no history of trauma, systemic upset, or any neurological symptoms prior to the onset of the pain. On examination he held his neck flexed and had restriction of all movements. Systemic …

Responses to this article

Free sample
This recent issue is free to all users to allow everyone the opportunity to see the full scope and typical content of EMJ.
View free sample issue >>

Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.


Among patients with minor TBI (GCS 13-15) getting CT scans ≥ 24 hours after injury, what proportion have a traumatic finding?


0.5% - 43% response rate
3% - 41% response rate
10% - 16% response rate

Related original article: PCT head imaging in patients with head injury who present after 24 h of injury: a retrospective cohort study

Navigate This Article