A Pain In The Neck

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Spondylosis of the cervical spine, or neck bones, occurs in nearly everyone as we age. It is a condition where the cervical vertebrae and the discs and ligaments that support the vertebrae, degenerate and break down. When the discs degenerate, there is loss of the space between the vertebrae, sometimes causing pressure on and squeezing of the nerves that exit from the spinal cord. This condition can also be referred to as simply arthritis of the neck. The term spondylosis comes from the Greek word spondylos, meaning vertebra. It commonly begins about age 40 but can be seen as early as the first decade of life. Studies have shown that 80 to 90% of people have disc degeneration on MRI scans by age 50. Spondylosis should not be confused with spondylolisthesis, a condition where a vertebra slips out of place in relation to the vertebra below it, although the cause of spondylolisthesis is often spondylosis.

Most people with cervical spondylosis have no symptoms and are not aware that they have the condition. If symptoms do occur, they usually consist of neck pain and stiffness. When more severe symptoms occur, such as tingling or weakness of the hands, feet, arms, or legs, difficulty with balance or walking, or loss of bowel or bladder control, medical evaluation is necessary. Risk factors for spondylosis include age, occupation (those involving repetitive neck movements or working in an overhead environment), neck injuries, genetic factors, and smoking.

Medical evaluation includes first ruling out other causes of neck pain such as a history of cancer (especially breast, prostate, or lung) or a history of IV drug use, weakened immune system, fever, diabetes, or recent serious infections (a risk factor for spinal abscess). Provocative tests may be helpful in examining someone with neck pain, especially if it extends (radiates) to the shoulder, limb, or hand on one side. The Spurling test, in which the patient’s head is turned to the side of the pain, the neck is slightly extended (the patient looks up), and pressure is placed on the top of the head. If this causes or worsens the pain, radiculopathy (a pinched nerve in the neck) is suspected. In the shoulder-abduction test, the patient’s palm or forearm of the affected arm is placed on top of the head. If this relieves the pain, radiculopathy may be the cause of the pain.

If spondylosis is suspected by the physical exam, it can be confirmed by X Rays, MRI, CT scan, or myelogram (dye is injected into the spine) of the neck. Also, an EMG (electromyogram) or nerve conduction study may confirm a pinched nerve. Treatment may include NSAIDs (Motrin, naproxen), oral steroids, muscle relaxants, gabapentin or pregabalin (may reduce nerve pain), or antidepressants (useful to relieve chronic pain). Physical therapy is often helpful as well and is usually recommended. Surgery is rare and is reserved for those with severe, unrelieved symptoms.

So, if you have chronic neck pain not caused by someone you know or live with, especially if the pain extends to one arm or hand, seek medical attention. Your doctor may be able to help.

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