Paediatric orthopaedics: Grisel syndrome: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Paediatric orthopaedics: Grisel syndrome

Sample item

A 7-year-old develops a painful, fixed head tilt to one side with rotation to the opposite side a week after a throat infection. Movement of the neck is limited and CT confirms fixed C1-C2 rotation. What is the diagnosis?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Atlantoaxial rotatory subluxation (Grisel syndrome)

Grisel syndrome is non-traumatic atlantoaxial rotatory subluxation that follows upper respiratory tract infection or ENT surgery, thought to be due to hyperaemia and ligament laxity from spread of infection. It presents with acute painful torticollis and is treated with a soft collar, traction and antibiotics if needed.

Option by option

  • A. Congenital muscular torticollis

    Congenital muscular torticollis is noted in early infancy with a sternocleidomastoid mass, not acutely at 7 years.

  • B. Ocular torticollis

    Ocular torticollis is a head tilt to correct diplopia and is not painful or fixed on CT.

  • C. Klippel-Feil syndrome

    Klippel-Feil syndrome is congenital cervical fusion with a short neck and low hairline.

  • D. Atlantoaxial rotatory subluxation (Grisel syndrome) (correct)

    Correct. Acute painful fixed torticollis after throat infection with C1-C2 rotation is Grisel syndrome.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is D, Atlantoaxial rotatory subluxation (Grisel syndrome). Grisel syndrome is non-traumatic atlantoaxial rotatory subluxation that follows upper respiratory tract infection or ENT surgery, thought to be due to hyperaemia and ligament laxity from spread of infection.

Why is "Congenital muscular torticollis" not the answer?

Congenital muscular torticollis is noted in early infancy with a sternocleidomastoid mass, not acutely at 7 years.

Why is "Ocular torticollis" not the answer?

Ocular torticollis is a head tilt to correct diplopia and is not painful or fixed on CT.

Why is "Klippel-Feil syndrome" not the answer?

Klippel-Feil syndrome is congenital cervical fusion with a short neck and low hairline.

What concept does this question test?

It tests Paediatric orthopaedics: Grisel syndrome in Orthopaedics. It presents with acute painful torticollis and is treated with a soft collar, traction and antibiotics if needed.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Paediatric orthopaedics: Grisel syndrome?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.