Cervical Osteoarthritis
Original Editors - Bram Sorel, Lisa Pernet
Lead Editors - Your name will be added here if you are a lead editor on this page. Read more.
Search Strategy[edit | edit source]
Databases used: Pubmed, Web of Knowledge, Pedro, Medal.org
Keywords Used: osteoarthritis, Cervical Arthrosis, Cervical spondylosis, Cervical Pain, Cervical Therapy
Definition/Description[edit | edit source]
Cervical osteoarthritis may be defined as a degenerative disorder of the synovial joints [3]. The disorder is associated with loss of hyaline cartilage, remodeling of underlying bone, formation of osteophytes at the joint margins and thickening of the joint capsule [2,3]. At the level of the cervical spine, the zygapophyseal joints are mainly affected by OA.
Although cervical osteoarthritis is often referred to as cervical spondylosis [1], it is not clear whether these two concepts may be considered synonyms.
Epidemiology/Etiology[edit | edit source]
Cervical osteoarthritis may be generalized, sometimes involving the entire cervical region, but it is usually more localized between the fifth and sixth and sixth and seventh cervical vertebrae.3
Everyone can have cervical osteoarthritis but it is rare in people younger than 40-50 years, the incidence increases with age [2,3]. Also women have a higher risk for cervical OA than men [3].4,5
The occurrence of cervical OA can have many causes. E.g. mechanically overstressing a joint (e.g. working with tools that generate intense vibration), past bone fractures or other injuries to the neck, overload at young age, posture asymmetry or asymmetric loading of a joint,… . A relation has been shown between the severity of the complaints of cervical osteoarthritis and a higher body weight of the patient. 6
Characteristics/Clinical Presentation[edit | edit source]
OA is characterised by pain, stiffness, crepitus, limited range of movement and sometimes also joint instability and mild synovitis [3,4,5]. The pain is usually localized around the affected joint , but at the level of the spine referred pain may occur. For the cervical spine, pain radiates to the occiput, the medial border of the scapula and the upper limbs [4]. Pain often worsens with joint use and is more severe at the end of the day. If there is morning stiffness, it usually lasts less than 30 minutes [3]. Restricted movement can occur due to pain, capsular thickening and the presence of osteophytes [3].
Pressure symptoms in the cervical spine are caused by Osteoarthritis of the uncovertebral joints. Osteophytes can form around the intevertbral joints and cause neurological symptoms due to compression of the spinal nerves [1]. Narrowing of the spinal canal can also cause circulation problems. Performing an MRI can be useful to confirm the presence of compression of the spinal cord.
The therapist must remain alert to several key characters, also called red flags, as this may indicate a more serious problem [4] :
- Malignancy, infection, or inflammation
- Fever, night sweats
- Unexpected weight loss
- History of inflammatory arthritis, infection, tuberculosis, HIV infection, drug dependency, or immunosuppression
- Excruciating pain
- Intractable night pain
- Cervical lymphadenopathy
- Exquisite tenderness over a vertebral body
- Myelopathy
- Gait disturbance or clumsy hands, or both
- Objective neurological deficit
- Sudden onset in a young patient suggests disc prolapse
- History of severe osteoporosis
- Drop attacks, especially when moving the neck, suggest vascular disease
- Intractable or increasing pain
Diagnostic Procedures[edit | edit source]
add text here relating to diagnostic tests for the condition
Outcome Measures[edit | edit source]
add links to outcome measures here (see Outcome Measures Database)
Management / Interventions
[edit | edit source]
The current standard therapy for Cervical OA consists of NSAID's, Exercise_Therapy, Manual_Therapy, Physiotherapy_/_Physical_Therapy and various operations.[1]
Functional status and disability measure can be assessed by Neck_Pain_and_Disability_Scale before and after therapy.
Magnetic therapy represents an alternative therapy for patients suffering from Cervical Osteoarthritis. Electromagnetic fields can be applied to treat Cervical OA. A pain-relief effect of PEMF has been proposed, but further studies are needed.[2]
Differential Diagnosis
[edit | edit source]
Kellgren and Lawrence developed a grading system for the radiological appearence of a joint with OA. The authors are from the University of Manchester and the Empire Reumatism Council Field Unit.
If more than one joint in a group is assessed, then the most severe grade is reported.
Parameters:
- osteophytes at the joint margins and periarticular ossicles
- narrowing of the joint space
- cystic areas with sclerotic wall in subchondral bone
- deformity of bone
| Radiological Appearence of OA | Grade |
| normal (no signs of OA) | 0 |
| doubtful | 1 |
| definite, minimal to mild | 2 |
| definite, moderate | 3 |
| definite, severe | 4 |
Key Evidence[edit | edit source]
add text here relating to key evidence with regards to any of the above headings
Resources
[edit | edit source]
add appropriate resources here
Case Studies[edit | edit source]
add links to case studies here (case studies should be added on new pages using the case study template)
References[edit | edit source]
References will automatically be added here, see adding references tutorial.
Levels of Evidence:
- ↑ Loy T. Treatment of cervical spondylosis. Med.J.Aust,2:32-34,1983 (Level C)
- ↑ Serap Tomruk Sutbeyaz,Nebahat Sezer,Belma Fusun Koseoglu. The effect of pulsed electromagnetic fields in the treatment of cervical osteoarthritis: a randomized, double-blind, sham-controlled trial. Rheumatol. Int.,26:320-324,2006fckLR(Level A2)
