spastic torticollis , also known as stiff neck or wryneck , is a condition in which the head is laterally flexed and rotated on the neck , secondary to painful spasm of the neck muscles . there may be a report of the patient having slept in a draft from a fan , open window , or air conditioner . the patient is generally afebrile , and if there is any history of trauma , it is of the mildest variety . chloroethane ( ethyl chloride ) spray is a vapocoolant applied topically in the treatment of athletic injuries . the manufacturer indicates that it may be used as a counterirritant in the management of myofascial pain and muscle spasm . we reviewed the literature and could find no large study on pediatric patients regarding this usage . we report our experience with the use of chloroethane spray treating torticollis in 66 patients ranging in age from 1 to 16 years . patients presenting to the pediatric emergency service of a 600-bed inner - city hospital with the compliant of  stiff neck  were selected for treatment . an initial evaluation was performed , which included a medical and family history , a physical examination , and x - ray study of the cervical spine ( a - p , lateral , and open mouth views ) . the patients were enrolled into either group 1 , usage of ethyl chloride spray , or group 2 , usage of normal spray . in the patients enrolled in group 1 ( after explaining the procedure to the parent and child and obtaining informed consent ) , the chloroethane spray bottle was held inverted 12 inches directly over the point of maximal neck tenderness . the valve of the bottle was opened , allowing the liquid to leave as a fine jet stream . the stream was left in contact with the skin for 4 to 5 seconds or until frosting of the skin occurred . the procedure was considered successful if , after a 5-minute waiting period , the patient was able to freely and painlessly move his or her head and neck in the opposite side . for the control group , normal saline is applied as a spray using a syringe with plastic catheter over the point of maximum tenderness and asked to move the neck after 5 minutes and note if patient can move the head and neck freely in the opposite side . a total of 132 children with a mean age of 8.97 years ( range = 1 - 16 years ) presented to the emergency room with torticollis over a period of 3 years and were enrolled in the study . of the 132 , patients in group 1 were treated with chloroethane spray and those in group 2 were treated with normal saline spray . of the 66 patients treated with chloromethane spray , 63 ( 95% ) responded to the treatment as evidenced by their subsequent ability to move the head and neck freely ( see table 1 ) . no patients returned for additional treatment . of the patients in group 2 , who treated with normal saline spray , no patient responded to saline spray with ability to move the head freely in the opposite side ( see figure 1 ) . series 1 : patients rxed with chloroethane spray ( 63/66 positive response and 3/66 negative response ) . the torticollis was in several cases associated with a local head or neck condition , but 46.97% of the cases involved no underlying pathology ( table 2 ) . of the 3 treatment failures , 2 occurred in patients with neck trauma and 1 failure occurred in a patient with cystic hygroma . conditions associated with spastic torticollis . abbreviation : uri , upper respiratory infection . to test the null hypothesis that the percentages improved in the 2 groups equally , we calculated the z statistic . the z statistic of 24 corresponded to a p value < .0001 , whether the test is 1-sided or 2-sided . to test the null hypothesis that the percentages improved in the 2 groups equally , we calculated the z statistic . the z statistic of 24 corresponded to a p value < .0001 , whether the test is 1-sided or 2-sided . torticollis is a condition in which the head is laterally flexed and rotated on the neck due to shortening or spasm of the sternocleidomastoid muscle . acquired torticollis can be caused by a variety of problems including cold exposure , minor neck muscle trauma , and any inflammatory condition of the neck such as cervical lymphadenitis , or retropharyngeal abscess . less common causes include drug ingestion ( eg , phenothiazines ) and a variety of neurological conditions such as dystonia musculorum deformans , brain stem , or posterior fossa tumor or cyst . we focus on describing chloroethane treatment for spastic torticollis caused by sternomastiod spasm that may be primary or secondary to a local inflammatory condition . this form of torticollis is most often treated with warm compresses , analgesics , and muscle relaxants . it is thought that the relief is the result of the wrong acting as a counterirritant or a local anesthetic or by a placebo effect . similarly , a vapocoolant therapy has been described to successfully relieve acute myofascial trigger with point pain in children . in conclusion , from our study , for children and adolescents with spastic torticollis , chloroethane spray was more superior to normal saline in the pediatric emergency room .
objective . a study to determine the efficacy of chloroethane spray compared to normal saline in the treatment of spastic torticollis in children and adolescents . hypothesis . 
 chloroethane spray is more superior to normal saline for the treatment of spastic torticollis in children and adolescents in the pediatric emergency room . 
 design . 
 prospective randomized study . setting . 
 urban inner - city hospital pediatric emergency department . 
 methods and results . all children and adolescents ( between the ages of 1 and 16 years ) presenting to the author with the complaint of stiff neck were enrolled in the study . 
 a total of 132 patients were enrolled . 
 after complete evaluation to rule out cervical spine injury , a central neurological cause , patients were enrolled in the study . 
 sixty - six patients were treated with chloroethane spray to the neck and the other 66 were given normal saline as placebo . 
 sixty - three out of 66 patients treated with chloroethane spray achieved relief in 5 minutes as demonstrated by painless and free movement of the head and neck . 
 no adverse effects were observed . 
 the patients treated with placebo have no relief in 5 minutes . to test the null hypothesis that the percentages improved in the 2 groups equally , we calculated the z statistic . 
 the z statistic of 24 corresponded to a p value of < .0001 , whether the test is 1-sided or 2-sided . 
 chloroethane spray treatment was superior to placebo with a high statistical significance . conclusion . 
 for children and adolescents with spastic torticollis chloroethane spray was more superior to normal saline in the pediatric emergency room .