Arthritis neck pain
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
Click here: Second Opinion Arthritis Treatment Kit
The spine is made up of 33 bones called vertebrae stacked on top of another to form a column.
The 7 bones in the neck are called "cervical vertebrae." Between the bones are pieces of cartilage called intervertebral discs. The backs of the vertebrae articulate via facet joints. Ligaments and muscles attach to the spine and connect the neck to the shoulder blades and upper back. The muscles control movements of the head. The spine supports the head and also protects the spinal cord.
Between each disc, nerve roots extend out from the spinal cord, passing through an opening in the side of the spine. The nerve roots in the neck join to form nerve trunks that run into the arms. Electrical impulses travel along these nerves, sending messages from the brain to the muscles.
The vertebral artery carries blood from the heart to the brain. It runs inside the bones of the spine and supplies the rear of the brain.
A stiff neck can occur without a demonstrable cause. It is the most common type of neck pain and often gets better after a few days.
The most common problem though occurs as a result of aging. Over the course of years the discs and the facet joints become worn. The discs become thinner and this causes the spaces between the vertebrae to become narrower. Also, "spurs" of bone, called osteophytes, form at the edges of the vertebrae and the facet joints. This condition is called osteoarthritis or cervical spondylosis.
Ligaments that support the neck can become stretched. Occasionally bulging discs or osteophytes pinch the nerve roots and this causes pain or numbness that travels into the arm.
With severe spondylosis, the spinal cord can be compressed; this causes weakness and numbness in the arms and legs.
Whiplash follows a rear-end collision in a car. Pain and stiffness in the neck usually is not immediate but comes on over a period of several hours.
Although whiplash can cause significant damage to the neck, the majority of people who suffer these accidents are not seriously injured. In most cases, people feel better within a few weeks or months. Unfortunately, some people develop chronic problems. Seat belts and proper headrests in cars have significantly reduced the damage from whiplash injuries.
People who are under stress often tighten their muscles more than is necessary to hold their head upright. This is a msjor cause of neck pain.
The pain may travel to the shoulder and between the shoulder blades or to the upper chest. Tension headaches can occur and the pain often travels to the back of the head and sometimes to the side of the head and behind the eye or even into the ear. If a nerve root is pinched, then numbness or tingling can be felt down the arm.
Stiffness is common. Stiffness is often worse after long periods of sitting in one position.
Clicking or grating can be felt with rotation or other movement of the head. This is caused by arthritis in the neck and is a common symptom.
Dizziness can sometimes happen when cervical spondylosis causes pinching of the vertebral artery. Dizzyness and even fainting can occur.
Long-lasting neck pain and stiffness can lead to feelings of depression and anxiety.
Pain may cause a person to stop moving the neck. If the condition is prolonged, this lack of activity can cause the neck muscles to become weak, and this reduces the ability of the cervical spine to support itself, compounding the problem.
Lack of exercise and poor conditioning of neck muscles is not good.
One note of good news: Most neck pain problems go away within a few days and do not need medical treatment. Resting for a few days is often all one needs.
Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen often help but one needs to be careful regarding potential side effects. Topical NSAIDS may be a better option than oral ones.
Gentle massage of the neck muscles often helps.
Simple exercises can help to restore range of movement, promote strength, ease localized stiffness and help get the neck back to normal. These should be done under the guidance of a physical therapist at first.
Simple stretching and strengthening exercises complement range of motion exercises.
Pain and stiffness can be caused by poor posture (slouching), weak shoulders, or a bed and pillow that aren't ergonomic.
"Desk hygiene" including the height of the chair, the position of the computer monitor, etc. may contribute to neck issues.
Imaging procedures such as magnetic resonance imaging or CT scanning and laboratory tests may be needed to look for other causes of neck pain such as ankylosing spondylitis, polymyalgia rheumatica, thyroid disease, and the like.
A specialist may recommend injections such as facet blocks or epidural injections. Sometimes we have used Botox with good results. Surgery is very rarely needed – only in severe cases of nerve or spinal cord involvement.
Physical therapy and chiropractic may be quite helpful.
Collars may provide relief. An option for use at night is a 'neck pillow', which is a specially shaped piece of molded foam that supports the neck.
Acupuncture can help relieve neck pain. At the moment there is no evidence that reflexology or a change in diet are effective.
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