CERVICAL SPONDYLOSIS

neck pain in spondylosis

DEFINATION

Cervical spondylosis is a common, age-related condition that affects the joints and discs in your cervical spine, which is in your neck. It’s also known as cervical osteoarthritis or neck arthritis.

It develops from the wear and tear of cartilage and bones. While it’s largely the result of age, it can be caused by other factors as well.
In the cervical spine this chronic degenerative process affects the intervertebral discs and facet joints, and may progress to disk herniation, osteophyte formation, vertebral body degeneration, compression of the spinal cord, or cervical spondylotic myelopathy

CERVICAL SPONDYLOSIS CAUSES

Bone spurs
These overgrowths of bone are the result of the body trying to grow extra bone to make the spine stronger.However, the extra bone can press on delicate areas of the spine, such as the spinal cord and nerves, resulting in pain.

Dehydrated spinal discs
Your spinal bones have discs between them, which are thick, padlike cushions that absorb the shock of lifting, twisting, and other activities. The gel-like material inside these discs can dry out over time. This causes your bones (spinal vertebrae) to rub together more, which can be painful.

Herniated discs
Spinal discs can develop cracks, which allows leakage of the internal cushioning material. This material can press on the spinal cord and nerves, resulting in symptoms such as arm numbness as well as pain that radiates down an arm. Learn more about herniated discs.

Injury
If you’ve had an injury to your neck (during a fall or car accident, for example), this can accelerate the aging process.

Ligament stiffness
The tough cords that connect your spinal bones to each other can become even stiffer over time, which affects your neck movement and makes the neck feel tight.

Overuse
Some occupations or hobbies involve repetitive movements or heavy lifting (such as construction work). This can put extra pressure on the spine, resulting in early wear and tear.

SYMPTOMS

1.Non-specific neck pain – pain localised to the spinal column.
2.Cervical radiculopathy – complaints in a dermatomal or myotomal distribution often occurring in the arms. May be numbness, pain or loss of function.
3.Cervical myelopathy – a cluster of complaints and findings due to intrinsic damage to the spinal cord itself. Numbness, coordination and gait issues, grip weakness and bowel and bladder complaints with associated physical findings may be reported.

OTHER SYMPTOMS..

1.Neck pain may spread to the shoulders, arms and hands, and the base of the skull. Moving the head may make the pain worse.
2.Neck stiffness is more common after a long period of inactivity, for example, after sleeping.
3.Headaches tend to start at the back of the head and then gradually move to the upper half of the front.
4.Some people may have dysphagia, or difficulty swallowing, if the bones press against the esophagus.

DIAGNOSIS

Physical examination
The doctor may ask the individual to make some movements, to check their range of motion.
These include:
1.moving the head sideways
2.moving the head forward and bringing the chin down to the chest

Imaging scans
1.An x-ray can  reveal any physical damage to the spine, and whether there are any bone spurs.

2.An MRI scan can also help pinpoint exactly where the problem is, and whether surgery is necessary.

MRI of spondylosis

3.A myelogram is another diagnostic test. A health professional will inject a colored dye into the spine. This dye shows in imaging scans, such as x-rays

4.A CT scan can help to assess the bony structure of the cervical spine.

5.Electromyography (EMG) and nerve conduction studies (NCS) can help to assess specific muscles and nerves.

EXAMINATION

Muscle atrophy is assessed on the affected side in the upper limb, shoulders and scapular regions and compared with the unaffected side. Muscle strength is tested in 4 muscles representing the myotomes C5-C8. Anterior, middle, and posterior parts of the deltoid muscle are tested by resisting flexion, abduction, and extension of the humerus. Strength of biceps brachii is assessed by resisted elbow flexion when the forearm is supinated. Triceps brachii muscle strength is tested by resisted elbow extension from 90 degrees of elbow flexion. The dorsal interosseus muscles are tested by resisting the separation of the 2nd through 5th fingers. Sensitivity to light touch and to pain are also tested for the relevant cervical dermatomes.

RISK FACTORS…

Factors other than aging can increase your risk of cervical spondylosis. These include:
1.neck injuries
2.work-related activities that put extra strain on your neck from heavy lifting ,holding your neck in an uncomfortable position for prolonged periods of time or repeating the same neck movements throughout the day (repetitive stress)
3.genetic factors (family history of cervical spondylosis)
4.smoking
5.being overweight and inactive

TREATMENT..

SURGERY
The mainstay of surgical treatment for degenerative cervical disorders involves decompression of the neural elements often combined this arthrodesis. Decompression may be achieved using an anterior, a posterior, or a combined approach. Recommended decompression is anterior when there is anterior compression at one or two levels and no significant developmental narrowing of the canal.

PHYSICAL MANAGEMENT

1.manual therapy
2.thrust manipulation
3.non thrust manipulation
4.postural education
5.thermal therapy
6.soft tissue mobilisation
7.home exercise

1.MANUAL THERAPY: is defined as high-velocity; low-amplitude thrust manipulation or non-thrust manipulation. Manual therapy of the thoracic spine can be used for reduction of pain, improving function, to increase the range of motion and to address the thoracic hypomobility.

2.THRUST MANIPULATION: of the thoracic spine could include techniques in a prone, supine, or sitting position based on therapist preference. Also cervical traction can be used as physical therapy to enlarge the neural foramen and reduce the neck stress.

thrust manipulation

3.NON THRUST MANIPULATION: included posterior-anterior (PA) glides in the prone position. The cervical spine techniques could include retractions, rotations, lateral glides in the ULTT1 position, and PA glides. The techniques are chosen based on patient response and centralisation or reduction of symptoms.

PA glide in prone

4.POSTURAL EDUCATION: includes the alignment of the spine during sitting and standing activities.

5.THERMAL THERAPY:provides symptomatic relief only and ultrasound appears to be ineffective.

6.SOFT TISSUE MOBILIZATION: was performed on the muscles of the upper quarter with the involved upper extremity positioned in abduction and external rotation to pre-load the neural structures of the upper limb.

soft tissue mobilization

7.HOME EXERCISES: include cervical retraction, cervical extension, deep cervical flexor strengthening, scapular strengthening, stretching of the chest muscles via isometric contraction of flexor of extensor muscles to encourage the mobility of the neural structures of the upper extremity.

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