Cervical Osteoarthritis
Original Editors - Bram Sorel, Lisa Pernet
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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]
The diagnosis is usually based on the clinical presentation [5]. Radiology can also be used to determine OA, but one must take into account that people with radiological signs can remain asymptomatic [3].
Kellgren and Lawrence developed a grading system for the radiological appearance of a joint with osteoarthritis [1].
| Radiological appearance of osteoarthritis | Grade |
|---|---|
| normal (no signs of osteoarthritis) | 0 |
| doubtful change (uncertain) | 1 |
| definite, minimal to mild | 2 |
| definite, moderate | 3 |
| definite, severe | 4 |
If more than one joint in a group is assessed, then the most severe grade is reported.
Parameters:
(1) osteophytes at the joint margins and periarticular ossicles
(2) narrowing of the joint space
(3) cystic areas with sclerotic walls in subchondral bone
(4) deformity of bone (altered shape)
Outcome Measures[edit | edit source]
Functional status and disability measure (evaluation of the activities of daily living) can be assessed by the “Neck Pain and Disability Scale”. [4]
Management / Interventions
[edit | edit source]
The main goals of management for cervical OA are reducing pain and stiffness, improving joint mobility and inhibiting further progression of joint damage [1,3]. The treatment is usually conservative, but if that is not successful, one can consider surgical treatment [1,3].
Various physiotherapy modalities can be used to reduce pain. Even though there is a lack of evidence for the application of local heat or cold, it is often used by patients with OA to decrease pain. TENS can also provide symptomatic relief. Pain may also be diminished using a medical treatment consisting of NSAIDs and [3,4,5].
There is also research into new methods to use in the treatment of OA to reduce pain. It is thought that magnetic therapy represents an alternative therapy for patients suffering from cervical OA. Electromagnetic fields can be applied to treat cervical OA and are thought to have a pain-relief effect, but further studies are needed [5].
Another important part of the management of OA is exercise therapy. The exercise program should aim at mobilization exercises, strengthening local muscles around the affected joint and improving overall aerobic fitness [3,4,5].
Finally, the treatment for cervical OA should also aim at providing information related to the disorder, stress management and postural advice in daily activities, work and hobbies [4].
Differential Diagnosis
[edit | edit source]
- Other non-specific neck pain lesions: acute neck strain, postural neck ache, or whiplash
- Fibromyalgia and psychogenic neck pain
- Mechanical lesions: disc prolapse
- Diffuse idiopathic skeletal hyperostosis
- Inflammatory disease: rheumatoid arthritis, ankylosing spondylitis, polymyalgia rheumatica, psoriatric arthritis, septic arthritis, reactive arthritis
- Metabolic diseases: Paget’s disease, osteoporosis, gout, or pseudo-gout
- Osteomyelitis or tuberculosis
- Malignancy: primary tumors, secondary deposits, or myeloma
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