Acute Torticollis    
Patient usually awakes with acute neck pain with neck flexed and rotated.
-  If possible straighten neck with gentle traction. Ethyl chloride spray may reduce muscle spasm.
-  Soft collar for maximum of 48 hours, analgesia.
- Many benefit from physiotherapy. 
 
Acute neck pain with or without root symptoms/signs                  
These patients should have a full neurological examination of the upper limbs.
- Discuss patients who have hard neurological signs with ED Senior re MRI. If out of hours bring patient back to early Review Clinic  
- Analgesia; NSAIDs and/or paracetamol with codeine (eg co-codamol 500/30) are the mainstay of treatment
- May benefit from Physiotherapy
- Many of these patients have long standing symptoms and in the absence of new hard neurological findings should be referred back to their GP