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 neck is a common site for arthritis to develop. The most common type of arthritis that affects the neck is osteoarthritis. This condition is also know an cervical spondylosis, cervical osteoarthritis, or degenerative joint disease of the neck.
Other forms of arthritis that can affect the neck are rheumatoid arthritis, psoriatic, ankylosing spondylitis, Reiter’s disease, gout, pseudogout, and diffuse idiopathic skeletal hyperostosis (DISH).
Cervical spondylosis is a condition that mainly affects older people, usually over the age of 40. Men are affected more often than women. Changes in cartilage metabolism lead to progressive wear and tear of discs and joints in the neck. Over time, the degenerative changes can cause a bulging or herniated disc, calcium build-up within the disc, or bony spurs on the spine. The end result is nerve compression or inflammation.
Also, the degenerating discs and bone spurs can lead to compression of the spinal cord.
Symptoms depend on the location of the nerve compression, but can include pain, numbness, arm or leg weakness, headaches, visual or hearing abnormalities, urinary problems, etc.
Symptoms consist of neck or shoulder pain, headaches in the back of the head, or stiffness of the neck. There is often difficulty turning or bending the neck from side-to-side.
Some patients will have pain that shoots down the arm. They may also notice numbness, weakness, or tingling in the arm. One or both sides may be affected. Often the problem can cause a clumsiness of the hands.
Some individuals will have numbness or weakness in their legs. This indicates that there may be pressure on the spinal cord (myelopathy). This is considered a surgical emergency. Many with this condition will have decreased vibration-sense in their legs. There may be unsteadiness of gait.
Some will notice a specific level on the chest or abdomen where there is a change in sensation.
Problems with urination may occur. There can be urinary frequency, urgency, retention, and incontinence. If this is present, it is a neurosurgical emergency.
The symptoms may get worse with turning, extending, or bending the neck. In others, coughing or straining may may worsen symptoms.
Physical exam may reveal numbness or weakness along a certain nerve distribution. The reflexes not as brisk as normal. The affected individual may have difficulty with turning the neck or bending it from side to side. The arms or legs may be stiff. The hands may be weak and there may be muscle atrophy in the hands.
Diagnostic tests are a must. CT and MRI scanning can be used to look at the spinal column and see if there is any narrowing or other abnormality.
Nerve conduction studies and electromyography can be done to test the nerves and muscles.
The primary treatment is to determine first, what type of arthritis is causing the problem. The second is make sure there is no instability in the neck. If there is, then it's critical to restrict neck movements. This is usually done with a cervical collar. If a cervical collar is not sufficient, then a more rigid brace for the neck may be necessary.
Medical treatment is usually with anti-inflammatory medicines, analgesics, and muscle relaxants. However, if this fails, then surgery may be necessary.
Physical therapy modalities including ultrasound, electrical stimulation, and traction supplemented by stretching and strengthening exercises may be helpful.
Patients may respond to steroid injections placed in the epidural space or in the facet joints.
If that does not work, then surgery to decompress the nerve and stabilize the neck may be necessary.
Surgery is usually done if:
Conservative measures such as physical therapy, nti-inflammatory medications, and injections do not work to relieve pain.
There are significant neurological deficits, such as difficulty walking, severe hand weakness, or bladder problems.
There is obvious compression of the spinal cord.
Cervical spondylosis needs to be differentiated from other less common conditions such as:
Amyotrophic lateral sclerosis
Subacute combined degeneration
Spinal cord tumors
Cervical rib syndrome
Brachial plexus neuropathies
Acute cervical disc herniation
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