Causes, Symptoms, and Treatment of Cervical (Neck) Osteoarthritis
An X-Ray of the Cervical Vertebrae
Osteoarthritis is the most common form of arthritis. It affects over 30 million Americans and most of them are women. It is typically caused by wear and tear on the joints, which can be caused by trauma, or other injury, but typically it is caused by aging.
The term osteoarthritis essentially means “bone and joint inflammation” because osteo is Greek for “of the bone,” arth meaning joint and –itis, which means inflammation. However, this term is actually misleading because osteoarthritis isn’t typically associated with inflammation until the later stages of the disease.
Cervical osteoarthritis can be extremely painful. It’s one of the most common forms of this type of arthritis and can affect anyone. It’s also a source of chronic pain and headaches for many people, including myself.
The Cervical Vertebrae
The vertebrae are not typical joints. They don’t have synovial fluid surrounding them, protecting them from friction and shock like the knees or elbows. Instead, they have a gel-like pad in between each vertebra known as the disc.
These discs are filled with a fluid that is comprised of degenerated collagen, proteoglycans and water. This gel-like center is called the nucleus pulpous, and it acts as the shock absorber for the vertebrae. It also keeps them spaced out.
There are seven cervical vertebrae and they are labeled C1, C2, C3 etc. C1 is the vertebra attached to the base of the skull and C2 allows the head to pivot. Because of this, these two vertebrae are under constant strain, and this predisposes them to osteoarthritis.
Anatomy of a Vertebra
A Herniated Disc
Osteoarthritis in any part of the spine is known by several names including degenerative disc disease, which is exactly what you think: degeneration of the discs.
Essentially the nucleus pulpous becomes dehydrated, and this causes compression of the vertebrae. At the same time, osteophytes (also called bone spurs) begin to form and as the vertebrae compress these spurs can put pressure on spinal nerves causing pain.
Eventually the discs degenerate to the point of bulging into the spinal canal. Sometimes the degeneration is so bad that the gel-like contents herniate into the spinal column, which can also put pressure on spinal nerves (see diagram).
Causes of Cervical Osteoarthritis
Our necks are constantly being used. From the time we get up to the time we go to sleep, our neck is in motion and supporting the weight of the brain and skull. Normal wear and tear on the vertebrae is a common cause of osteoarthritis of the spine, and specifically the neck.
The Trapezius Muscle
There are a number of other things that can cause osteoarthritis to settle into the cervical vertebrae. It’s typically a result of the aging process, but it can occur in young people as well, and that’s usually the result of one of the following:
- Whiplash caused by a blow to the head or a rear-end motor vehicle accident
- Poor posture
- Staying in the same position for long periods (surgeons typically have cervical osteoarthritis because of their head position during surgery).
- Repetitive movement (such as “head banging”)
- Sports injuries to the neck
- Compression caused by muscles in constant spasm (the trapezius muscle is the most common culprit)
Movement of the Neck
Symptoms of Cervical Osteoarthritis
Symptoms for all forms of osteoarthritis are very similar. However, cervical osteoarthritis has several characteristic symptoms that allow it to be easily distinguished from other forms of arthritis. These symptoms include:
- Muscle pain (especially in the trapezius muscle)
- Stiffness in the neck
- Inability to turn the neck completely to either side
- Pain in the neck
- Pain that only subsides when laying down
- Weakness, tingling or numbness in the arms
- Psychological effects of chronic pain
- Problems performing routine tasks and hobbies
- Sometimes complete and permanent disability
These are just a few of the symptoms. However, the headaches and migraines are the most disturbing to those who have been just diagnosed or are just developing the disease. The typical reaction is “But my neck doesn’t hurt.”It doesn’t have to.
Headaches can be caused from the compression that is the result of the discs degenerating and ultimately collapsing. Cervical osteoarthritis headaches are very distinctive, but are often misdiagnosed.
These headaches start at the very base of the skull and are usually unilateral (on one side of the neck). The pain then extends from the base of the skull up and over the top of the head and sometimes even to just behind the eye on the affected side.
However, both sides of the neck and head can be affected at the same time if the muscles are in spasm on both sides.
The compression can also cause any bone spurs to cut off the circulation of the cervical spinal fluid or put pressure on spinal nerves, most commonly the greater occipital spinal nerve.
This can trigger a migraine almost instantaneously along with all the symptoms that come with it including nausea, photophobia (light sensitivity), phonophobia (sensitivity to sound), vomiting and, of course, severe head pain.
Treatment of Cervical Osteoarthritis
Treatment typically involves management of the pain and other symptoms.
Pain medications can be very helpful in getting symptoms under control and allow the patient to resume some of their normal activities. Medications commonly used to alleviate pain from osteoarthritis include:
- Voltaren gel
- Tramadol (Brand name Ultram)
- Naproxen sodium
- Steroids (particularly prednisone)
- Celecoxib (Brand name Celebrex)
- Narcotic pain killers (Vicodin, vicoprofen)
Other treatments can include physical therapy, a change in lifestyle, the addition of exercise into the daily routine, and even a change in diet.
Treatment with Physical Therapy
Physical therapy helps to alleviate the stiffness that is caused by osteoarthritis. It can also help alleviate headaches. I know this from personal experience.
I have migraines due to compression of the cervical vertebrae C1, C2, and C3. This is the result of an injury sustained from a car accident many years ago. However, the injury caused osteoarthritis to develop along with bone spurs, which instigate the migraines.
Any time I went to my physical therapist and happened to have a migraine, the minute he started using manual traction on my neck to open the compression of the vertebrae, my headache magically disappeared, and the frequency of my headaches decreased considerably after several sessions.
Cardio and weight training exercise can work wonders for osteoarthritis. The movement prevents the stiffness so characteristic of osteoarthritis and the endorphins help to relax the muscles in the neck alleviating compression.
Weight training builds muscle, which also prevents compression because the muscles will help hold the vertebrae in place taking some of the pressure off of the discs.
However, weight training can exacerbate compression in muscles that are in constant spasm. It's important to speak with your doctor or physical therapist before starting any weight training program.
Making changes in your lifestyle such as alleviating a position that is known to exacerbate your arthritis (such as working on a computer, or driving) can do wonders in the prevention of further deterioration. While all positions can’t be avoided forever, it may be possible to change or correct your posture during these activities providing the same effect as avoiding them.
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