OBJECTIVE: To discuss the diagnosis, management and possible mechanism of atlantoaxial rotatory fixation.

CLINICAL FEATURES: An 11-yr-old girl with significant head tilt of 7 months' duration sought chiropractic evaluation. Her history included indirect head and neck trauma from a motor vehicle accident and prior manipulative and therapeutic treatment. There was minimal muscular hypertonicity, except for the sternocleidomastoid muscle on the side opposite head tilt. The head seemed to be locked in a classic "cock robin" position. Radiological examination revealed asymmetry of the atlanto-odontoid interval, suggesting occipital-atlantoaxial joint dysfunction. A diagnosis of atlantoaxial rotatory fixation was made.

INTERVENTION AND OUTCOME: Treatment included vectored/linear, upper cervical, high-velocity, low-amplitude chiropractic manipulation of the atlas vertebra, mobilizing manipulation and stretching exercises. Complete resolution occurred.

CONCLUSION: This single case study suggests that chiropractic manipulation may be a viable treatment option for atlantoaxial rotatory fixation. Further investigation into manipulation as a treatment should be pursued.

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