Arthritis in the neck is a common cause of neck pain among the middle aged and elderly. It is also known as cervical spondylosis
It affects over 85% of those over 60. It is usually caused by progressive degeneration (wear and tear) of the joints and disks of the upper spine over time.
Together with neck pain, the most common symptom of arthritis in the neck is stiffness at the back of the neck.
However, it is not uncommon for someone with this condition to actually experience no symptoms at all. It is thought that one in five patients are symptom free.
Like most types of arthritis, this is an unpleasant condition. However, the good news is that it usually responds well to conservative treatments. Only a small proportion of patients requires surgical intervention. The most common treatments are medication and physical therapy. We shall briefly describe these treatment options later in this article.
In this article, we shall first briefly describe the anatomy of the spine. We will then trace the processes that cause neck arthritis to develop.
We shall then describe the symptoms of this condition in greater detail. Finally, we shall go over the treatment options, focussing on the conservative (non surgical) therapies.
As usual, the opinions in this article should not be regarded as medical advice. We would always suggest that you review the most suitable treatment options for your neck arthritis with your physician.
Spinal Anatomy & The Causes Of Neck Arthritis
The human spine is made up of 24 small bones stacked vertically. These are called vertebrae and together they form a channel (or canal) that surrounds and protects the spinal cord.
The vertebrae are separated by flexible disks that help to absorb the impacts between the vertebrae when we walk or run.
The cervical spine is the upper portion that comprises the first 7 vertebrae and starts at the base of the skull. This is the area that is usually affected by neck arthritis.
How Neck Arthritis Develops
Neck arthritis is the result of degeneration of the vertebrae and discs of the spine with aging.
These changes occur in almost everyone and are a normal part of the aging process. However, only some of us will experience the pain and discomfort of cervical spondylosis.
The spinal disks start to flatten and bulge as age progresses. They also lose hydration and begin to dry out, making them more brittle.
As these changes take place, the disks become progressively less effective at cushioning and absorbing the shocks to the spine. As this happens, we experience neck pain while walking due to the shocks to the cervical spine.
The connections between the bones of the spine, or facet joints, also change with age. The cartilage that prevents direct contact between the bones deteriorates, making direct contact between the bones more frequent. This is similar to the wear and tear that causes hip or knee osteoarthritis.
The increased contact between bones can prompt the body to produce new growths of bone in the facet joints. These are called bone spurs.
Bone spurs increase the support for the spine. But they also reduce the space for the spinal nerves and cord that the spinal canal needs to accommodate.
Over time, this process can lead to pinched nerve roots and spinal stenosis. Thus, the presence of bone spurs increases the likelihood of referred arm pain due to pinched or compressed nerve roots. It can also reduce the range of motion of the spine. This in turn contributes to the neck stiffness that is characteristic of this type of arthritis.
Risk Factors For Neck Arthritis
The following factors can increase the propensity for spinal degeneration and the resulting disk and facet joint deterioration:
Family history that includes a high incidence of neck arthritis and spondylosis;
Smoking is also believed to exacerbate the process;
Performing daily tasks that require plenty of neck movement (particularly working overhead);
Previous neck injury; and
Persistent depression or anxiety.
Symptoms Of Neck Arthritis
As mentioned above, many people with spinal degeneration actually experience no tangible symptoms of the condition. However, when symptoms do occur, they usually include the following:
Chronic neck pain, sometimes associated with tenderness, particularly after holding the head or neck in the same position for a period;
Stiffness in the neck;
Grinding (crepitus) or other audible sounds (e.g. popping) when trying to move the neck;
Weakness in the arms or legs. This is a result of the narrowing of the spinal canal and the pinching of spinal nerves;
Difficulty maintaining balance while walking;
Muscle spasms – usually in the neck or shoulder area.
Referred or so-called ‘radicular’ pain in the arm and/or forearm. This is caused by nerve root irritation or compression.
Diagnosing Neck Arthritis
To diagnose this condition, a doctor will usually review your medical history and perform a physical examination. The latter will usually include evaluating arm, neck and shoulder strength as well as reflexes, touch sensation and blood flow in those areas. Joint flexibility and blood flow will also be evaluated.
In some cases, doctors will request imaging studies such as an X ray examination, CT or MRI scan.
X rays will help to reveal abnormalities in bone structure or the presence of bone spurs. MRI scans on the other hand will produce images of soft tissues. Your doctor can use this information to assess the extent to which your symptoms are due to soft tissue damage (e.g. herniated disks or pinched or compressed nerve roots).
Treating and Managing Neck Arthritis
As with most conditions, the first treatments attempted will be conservative (non surgical). They will usually include:
Physical therapy to relieve pain and improve flexibility. A physical therapist will devise a program of exercises that may last between 6 and 8 weeks for this purpose.
Over the counter pain relief medications such as Tylenol (paracetamol) may be tried in the initial treatment stages;
Other classes of medications that may be considered are:
Muscle relaxants – like diazepam; indicated if muscle spasm is present
Non steroidal anti inflammatory drugs (NSAIDs) like ibuprofen (advil)
A type of orthotic that may be tried is a cervical collar. This will help to restrict neck movement and allow injured muscles to recover. However, care should be taken not to overuse this device as it may cause weakening of neck muscles. It is recommended only for short term use of not more than about one week. Up to 50% of patients will experience improvement in their symptoms with a collar;
Steroid injections may be effective in relieving neck or arm pain. These may lead to complications, however, and should be thoroughly discussed with the doctor before proceeding;
A recent innovation in treating neck arthritis due to degeneration of facet joints is a procedure called ablation. The doctor will first try to identify the location of the cause of the pain by blocking the nerve supplying the joint with a local anesthetic. If the patient reports pain relief, the doctor will then block the pain more permanently by “ablating” or damaging the nerve involved. This will usually relieve the pain until the nerve regenerates, when the pain can return.
Conservative treatments are likely to be successful even when minor or stable neurological symptoms are present.
Surgical intervention is indicated in a small proportion of patients. This is the case if there are signs of abnormal neurology or persistent or progressive arm pain with or without abnormal neurology. These interventions include removal of bone spurs or other procedures to decompress affected nerve roots. These procedures are usually combined with spinal fusion.