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Method to Measure Tone of Axial and Proximal Muscle
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Atlantoaxial rotatory fixation.

Peter M Cirrincione1, Jessica H Heyer2

  • 1Department of Orthopaedics, University of Illinois Chicago, Chicago, Illinois.

Current Opinion in Pediatrics
|October 2, 2025
PubMed
Summary

Atlantoaxial rotatory fixation (AARF) is a treatable condition often mistaken for torticollis. Early diagnosis and noninvasive treatments, like rest and medication, lead to excellent outcomes, frequently avoiding surgery.

Keywords:
Grisel's syndromeatlantoaxialatlantoaxial rotatory fixationatlantoaxial rotatory subluxation

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Area of Science:

  • Orthopedics
  • Pediatric Neurology
  • Sports Medicine

Background:

  • Atlantoaxial rotatory fixation (AARF) is a complex condition that can be misdiagnosed as torticollis.
  • Prompt recognition by primary care physicians is crucial for effective management.
  • Understanding the etiology and presentation of AARF is key for timely intervention.

Purpose of the Study:

  • To provide an updated review on the diagnosis and treatment of AARF.
  • To highlight the importance of early suspicion and noninvasive management strategies.
  • To differentiate AARF from similar conditions like torticollis.

Main Methods:

  • Literature review focusing on recent advancements in AARF diagnosis and treatment.
  • Emphasis on clinical presentation and diagnostic imaging.
  • Evaluation of nonoperative and operative management outcomes.

Main Results:

  • AARF commonly follows upper respiratory viral infections.
  • Early diagnosis allows for successful nonoperative treatment, including rest, cervical collars, and medication.
  • Noninvasive measures can lead to full resolution and prevent the need for surgery.

Conclusions:

  • AARF is a treatable condition, with surgery often unnecessary.
  • Dynamic computed tomography (CT) is the preferred imaging modality for diagnosis and confirming resolution.
  • Diagnosis requires evidence of pathological subluxation between C1 and C2 vertebrae.