= arthritis of the neck degenerative condition affects the vertebral bodies, the intervertebral...
TRANSCRIPT
= Arthritis of the neck
Degenerative condition Affects the vertebral bodies, the
intervertebral discs ,the facet joints and eventually the contents of the spinal canal
Involves the degeneration of cartilage and the formation of osteophytes (spurs)
Results in pain and stiffness Worsens with age
Definition
Pathophysiology
Denegation that occurs naturally with age
Occurs in the facet joints and the intervertebral discs
Discs lose water and weaken
Movement segment
Increase in mechanical stress at cartilage end plates with an increase in pressure at the facet joints
Cartilage therefore gets worn away and results in bone on bone contact
Body response is the formation of osteophytes=spurs
Supports the decaying vertebrae
Creates a narrow space for nerves to pass
Disc: Decreased elasticity of annulus fibrosis Loss of fluid in nucleus pulposesTherefore unable to withstand compression
forces and bulges decrease in disc height
Formation of osteophytes:◦ Forms where tension is the greatest◦ Forms at the edges of the vertebrae
Facet joints In closer contact due to decreased height of
the disc
Stretching of the capsule due to inferior facet moving down on the superior facet
Facet joints move into a position of extension
and therefore experience an increase of stress during normal daily activities
Vertebral body: Development of sclerosis= hardening of
tissue/structures
Intervertebral foramen: Decreased due to the formation of
osteophytes and loss of disc height
Spinous processes: Formation of a false joint due to the spinous
processes coming into contact with one another
Three stages occur during degeneration1. Dysfunction
◦ Dysfunction of the trunk fascia, muscles , ligaments, capsule, neural structures and z-joints.
◦ Results from mechanical stress , injuries and overuse injuries
2. Instability◦ Disc mal-alignment and degeneration due to a
loss of protection from these structures ◦ Results in segmental stability
Age –especially above 60 years Family history of neck pain Overweight Sports Occupations involving excessive
neck motion/overhead working Previous neck injury/trauma Ruptured/slipped disk
Causes and Risk Factors
Signs and Symptoms Can develop
◦ Slowly◦ Sudden onset
Headaches Neck stiffness Weakness
◦ Difficulty with lifting arm or squeezing hand
Abnormal sensations or numbness◦ Shoulder/arms/legs
Pain◦ Mild◦ Severe
Location: behind neck , m.trapezius, upper arm, forearm and fingers
Aggravated by: ◦ Sudden movements◦ Stretching at end range
Worse in the morning
Signs and Symptoms
Signs and Symptoms Loss of balance Muscle spasms of
neck and shoulders Grinding/popping
noise with movement Reduced reflexes Difficulty rotating
head in all directions
Conservative: Physiotherapy
◦ Strengthening of neck muscles◦ Stretching◦ Neck traction◦ Posture therapy◦ Ice/hot packs◦ Care of the neck and advice◦ Passive mobilisations
Medical Management
Medication◦ NSAIDS (aspirin,ibuprofen)◦ Muscle relaxants◦ Steroid injections◦ Anti convulsants/antidepressants◦ Narcotics/opiods (not on a daily basis)
Soft collars NB ! Short term only!◦ Limits neck motion
Medical Management
Surgery (foraminotomy ,laminectomy , spinal fusion)◦ Uncommon◦ If conservative management fails◦ Only for severe pain◦ Neurological symptoms
Medical Management
Long lasting Cervical Radicular Pain Managed With Surgery , Physiotherapy , or a Cervical Collar: A Prospective ,Randomized Study .
Compared the effect of surgery, physiotherapy and a cervical collar on cervical radicular pain as a result of cervical spondylosis
Included 81 patients who have experienced cervicobrachial pain for at least 3 months
Research
The pain must be a direct result from a root compression with or without a bulging disc
Patients were randomly allocated to each treatment method
It was concluded at the end of a 12 month evaluation that either method was a successful as the next
This implied that the condition is dominant in its degeneration
Persson,L.C.,Carlsson,C.,Carlsson,J.1997.Long-Lasting Cervical Radicular Pain Managed With Surgery ,Physiotherapy , or a Cervical Collar : A Prospective ,Randomized Study . Sweden : Lippincott , Williams & Wilkins.
Fox.M.L.2009.American Academy of Orthopaedic Surgeons.
http://orthoinfo.acios.org/topic.cfmRetrieved on 12 May 2012.
References
Vorvick,L.J .,Benjamin,C and Zieve,D.2011.National Center for Biotechnology Information:US National Library of Medicine.
www.ncbi.nlm.nih.gov/pubmedhealth/PMH0014721Retrieved on 12 May 2012.
Barnes,R.2011.NEUROMUSCULAR-SKELETAL REHABILITATION DICTATE.(Unpublished dictate.) University of the Free State , Free State.