Diagnosing early cervical dystonia and using botulinum toxin has been one of the major advances I have seen in my treatment. Sidebend or Rotation to one side can be subtle but very important as one can now get drug coverage for botulinum. Recently, one author noted that the shirt collar was asymmetrical as well.
The “shirt collar sign” of cervical dystonia
Michael R. Silver, John Hanfelt & Stewart A. Factor
International Journal of Neuroscience Volume 127, 2017 – Issue 5; 466-468
Comment:
botox site give clear idea of which muscles and what dosages to use:
https://www.botoxmedical.com/CervicalDystonia/DosingAndAdministration
Had couple of cases that took years to diagnose
- very spastic levator scapula among other muscles – never got much head tilt as I was always injecting things free…
- Case which had bilateral sternomastoid spasms- wife noticed he could never look up