Cervical Spondylosis

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EPIDEMIOLOGY

Evidence of spondylotic change is frequently found in many asymptomatic adults, with 25% of adults under the age of 40, 50% of adults over the age of 40, and 85% of adults over the age of 60 showing some evidence of disc degeneration. Another study of asymptomatic adults showed significant degenerative changes at 1 or more levels in 70% of women and 95% of men at age 65 and 60. The most common evidence of degeneration is found at C5-6 followed by C6-7 and C4-5.

CAUSES

Possible causes of the condition include:

Degenerative Disc Disease

Bone Spurs

Herniated discs

Dehydrated Spinal discs

Injury (Acute/Chronic)

Ligament Stiffness

Overuse injury

Risk factors include :

Aging

Work related Activities putting excesse stress on neck

Repetitive Stress

Genetics

Smoking

Being overweight and physically inactive

CLINICAL FEATURES AND PATHOPHYSIOLOGY

Common symptom is pain around neck and shoulder blade. Some complain of radicular pain along the arm and also in the fingers . The pain might increase when:

standing
sitting
sneezing
coughing
tilting your neck backward

Another symptom is muscle weakness. Muscle weakness makes it hard to lift the arms or grasp objects firmly.

a stiff neck that becomes worse

headaches that mostly occurs in the back of the head

Tingling and Numbness that mainly affects the shoulders and arms, although it can also occur in the legs

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PHYSICAL EXAMINATION AND DIAGNOSIS

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Spurling Sign

https://youtu.be/3ZSNdv0o0yk

Lhermitte Sign

https://youtu.be/nIPIkaVTbrE

Other test includes

Cervical Distraction Test

https://youtu.be/uLdzgd5snmw

Another occasionally useful test is the pectoralis muscle reflex.

This is elicited by tapping the pectoralis tendon in the delto-pectoral groove, which causes adduction and internal rotation of the shoulder if hyperactivity is present. A positive result suggests compression in the upper cervical spine (C2-C4).

Plain radiographs of the cervical spine may show a loss of normal cervical lordosis, suggesting muscle spasm.

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PHYSIOTHERAPY MANAGEMENT

Mobilisation or manipulations in combination with exercises are effective for pain reduction and improvement in daily functioning in sub-acute or chronic mechanical neck pain with or without headache.

There is moderate evidence that various exercise regimens, like proprioceptive, strengthening, endurance, or coordination exercises are more effective than usual pharmaceutical care

Treatment should individualised, but generally includes rehabilitation exercises, proprioceptive re-education, manual therapy and postural education

Manual therapy

It is defined as high velocity, low amplitude, thrust manipulation or non thrust manipulation. Manual therapy of the thoracic spine can be used for reduction of pain, improving function, to increase the range of motion and to address the thoracic hypomobility

Thrust manipulation

Thrust Manipulation of the thoracic spine could include techniques in a prone, supine, or sitting position based on therapist preference. Also cervical traction can be used as physical therapy to enlarge the neural foramen and reduce the neck stress.

Non-thrust manipulation

It includes posterior-anterior (PA) glides in the prone position. The cervical spine techniques could include retractions, rotations, lateral glides in the ULTT1 position, and PA glides.

Postural education

It includes the alignment of the spine during sitting and standing activities.

Thermal or Heating therapy

It provides symptomatic relief only.

Soft tissue mobilisation

It was performed on the muscles of the upper quarter with the involved upper extremity positioned in abduction and external rotation to pre-load the neural structures of the upper limb.

Home Exercices

It includes cervical retraction, cervical extension, deep cervical flexor strengthening, scapular strengthening, stretching of the chest muscles via isometric contraction of flexor of extensor muscles to encourage the mobility of the neural structures of the upper extremity

For more info related Stretches and Exercises for Cervical Spondylosis visit

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