Saturday, 20 September 2014

CERVICAL SPONDYLOSIS

CERVICAL SPONDYLOSIS
Cervical spondylosis is usually an age-related condition that affects the joints in your neck. It develops as a result of the wear and tear of the cartilage and bones are of the cervical spine. While it is largely due to age, it can be caused by other factors as well. Alternative names for it include cervical osteoarthritis and neck arthritis.

Spending hours bent over a computer or laptop or carrying heavy handbags can often have us reaching for the back of our neck, massaging it for some form of pain relief.


What is cervical spondylosis? 


Cervical spondylosis is another name for osteoarthritis in the joints of the vertebrae in the neck. This means that it is a degenerative disease where bony surfaces, in this case in the cervical vertebrae, have lost their cartilage lining. If there is inflammation of the joint associated with this degeneration, one would use the term, spondylitis to describe it.

the discs–that lie between successive vertebrae. Just as a degenerated joint alone will produce some symptoms of its own, a degenerated will be responsible for some, possibly different, complaints too.

Who can suffer from it? What predisposes people to this condition?

Changes will be seen on x-ray in anyone who is around 50 years of age. Changes are seen earlier and to a greater degree in those whose joints have been subjected to strain more than usual. Strain could be owing to excessive body weight, the spinal column being a weight-bearing structure, poor muscle tone or bad posture, and there is, of course, a genetic predisposition to this disease. Arthritis tends to run in families.


Symptoms


Neck and shoulder pain are the most common symptoms. Types of neck and shoulder pain include:

  • Stiff neck, most often one of the very first signs. 
  • Neck stiffness tends to grow progressively worse over time.
  •     Radiating pain to the bottom of the skull and/or to the shoulder and down the arm. This radiating pain may seem like a stabbing or a burning, or it might present itself as a dull ache.

Along with pain, cervical spondylosis can be accompanied by parathesias and muscle weakness in the neck, shoulders, arms and hands, and a syndrome called “numb, clumsy hands”. In cases of cervical spondylosis with myelopathy, the legs may be affected, leading to an interruption of stability while walking. Loss of balance might also occur. When myelopathy is present, incontinence may become a problem. Muscle wasting also accompanies cervical spondylosis with myelopathy.

How can one prevent the onset of the condition?

The onset of osteoarthritis can be slowed down with

  •     Weight loss
  •     Exercises specific to the joint is question so that the transmission of weight through it is more balanced
    Intake of a balanced diet, in terms of the calorific and protein intake, and one which provides anti-oxidants (vitamins and minerals) in sufficient quantity. I recommend fish, fresh fruits and milk/yoghurt to one and all.
    Ensuring that the joints (in the neck in this case) are not subjected to persistent and repetitive strain and stress, which means that one should take frequent breaks, and perhaps stretch a little, while one is to work
    There are some medicines which will make the cartilage lining stronger, and if the treating doctor deems fit, they can be tried, in addition. Such medicines are of no help in advanced disease when there is no cartilage left to strengthen. And hope for the best!


DIAGNOSIS
Doctors diagnose cervical spondylosis by means of neck flexibility tests and imaging techniques.

Neck flexibility tests are used to identify any instability that may be present in the neck. The tests include:

  •    Tilting head to either side,
  •     Rotating head to either side


An x-ray of the Cervical Spine is usually enough to confirm the diagnosis of spondylosis/spondylitis, if suspected.

 
 When the patient presents to him, the doctor will take a detailed history and conduct a thorough clinical examination, and will, once in a while, order more tests like an MRI to look for the effects of the spondylosis in structures that don’t show up on x-ray, and to correlate the changes and effects with the patient’s symptoms.

degenerative changes seen on x-ray.

Other imaging diagnostics include:

    MRIs – Particularly useful for viewing the condition of the spinal nerves and the spinal cord. MRIs take pictures from many angles.
    CT scans provide good views of the bones, especially where they encroach on nervous tissue due to their reshaping over time.

MYELOGRAM
  This imaging technique enhances the visibility of x-rays. They are especially good for seeing problems located at nerve roots.
Physiotherapy and exercises remains the mainstay of treatment. Physiotherapy is safe and reduces inflammation and pain; exercises keep your joints moving.

Risk Factors for Cervical Spondylosis

Cervical spondylosis is common in people who have had neck injuries. Below is a list of common pre-cursors to neck arthrtis relevant to active people:

  •     Carrying axial loads on your head (for example, carrying a heavy surfboard down the beach to the waves)
  •    Professional dancing
  •     Professional gymnastics.

For more typical cases of neck arthritis, congenital, genetic and acquired risk factors have been identified by researchers. You might consider that:

    Neck arthritis, like some other types of back problems, may run in families.
    A congenitally narrow spinal canal increases the risk of developing cervical spondylosis with myelopathy. With a narrow spinal canal, the spinal cord -- a very sensitive structure that relays feelings to the brain and movement commands from the brain to the muscles -- has less space to fit inside the column of bone it occupies.

    Narrowing of the spinal canal can also be caused by thickening of spinal ligaments and bone; although these are age related changes, they have the same effect as congenital narrowing.

Treatment of neck arthritis (cervical spondylosis) generally aims to reduce pain and irritation to spinal cord and nerves, while also improving activities of daily living. Treatment modalities may include:

  •     Use of a neck brace to immobilize the neck
  •     Medication
  •    Physical therapy
  •     Possible traction and epidurals, depending on the findings from diagnostic imaging tests.

It is time to seek medical help for cervical spondylosis when:

  •     your over-the-counter pain mediation does not keep your pain at bay
  •     your pain continues to worsen
  •     your arms and/or legs develop numbness
  •     you experience weakness
  •     you experience bowel or bladder incontinence

Cervical traction can be used for a variety of purposes. It can be used to help decrease compressive forces in the neck, which can help take pressure off of the discs that reside between the vertebrae (spinal bones) in the neck. It can also open up the spaces where nerves exit the spinal canal, which can help relieve pressure off of a compressed nerve. Traction can also help stretch the muscles and joint structures around the neck.


PHYSIOTHERAPY TREATMENT


Heat Modalities

Heat is an effective mean of reducing and relieving pain in cervical osteoarthritis. The modalities that can be used are:-


a)Hot packs for moist heat.


b)SWD (pulsed or continous) for dry heat.

Once the pain subside to a tolerable limit, then exercises should be started and progressed gradually according to the conditions and requirements of the patient.

Static Contractions and Strengthening Exercises

Isometric contractions of the cervical muscles improve the muscle endurance and tone as the contractions improve the blood supply thereby the nutrition to the muscle is increased and hence muscle strengthening is done.


The basic technique of this exercise is that both Physiotherapist and patient exert equal pressure so that static; non dynamic action takes place in the cervical muscles. During all the movements, shoulder girdle should be stabilised so as to avoid trick movements. The pressure can be applied by the physiotherapist or by the patient himself after teaching him the technique properly.

Soft tissue technique

Kneading helps to release tightness of upper fibre of trapezius. Picking up, wringing and skin rolling also helps in relieving the tightness of scalene muscles, interspinous ligaments, paravertebral muscles and trapezius.

Traction

Oscillatory traction is considered to be effective in mobilizing the stiff neck. Continuous traction is used to relieve nerve root pressure.

Traction is always given in comfortable position with minimum weight which should be graduated slowly as for the patient's recovery. This depends on the frequency of remissions and exacerbations of the condition. It can be given in sitting or lying position. The traction can be given either in the form of manual traction or positional traction.

Hydrotherapy

Postural Awareness

As the condition progresses, the abnormality of posture also increases, thus from the initial stage itself, postural awareness through proper advice and education should be planned and initiated by the physiotherapist.

The ideal posture is straight neck with chin tucked in and back straight with no compensatory actions or any trick movements. While sitting a high backed chair is provided to the patient with head, neck and shoulder supported; a small pillow in the lumbar spine, feet properly supported and arms resting on a pillow over the lap or on the arms of the chair.

While sleeping, side lying is the most preffered position, supine lying is also adviced. A single pillow under head for head support is allowed. A Butterfly pillow is the best support for a patient

Support

Support for the neck are of great importance to keep the neck steady and to relieve the pain. A firm neck collar is very beneficial especially during activities or during travelling. While patient is resting or sitting, the collar should be removed but then also the neck should be supported by pillows or head rest.

Relaxation

Due to pain and spasm of cervical muscle, patient is always in discomfort and uneasiness. So to alleviate these undesirable situations, relaxation techniques are taught in various positions that is during rest, work or play.

While lying on bed, patient is adviced to loosen his entire body and stretch for few times so as to reduce the muscular tension to a minimum. While relaxing the whole body should be fully supported by pillows. He is then encouraged to think of something pleasent which will facilitate comfortable and relaxed sleep.

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