CERVICAL SPONDYLOSIS – “POPPING AND CRUNCHING”
Spondylosis refer to degenerative changes or wear and tear of the small facet joints which provide stabilization of the spine. The facet joints are similar to other joints in the body like the knee joint in that there are cartilage surfaces, joint space, a synovial membrane and fibrous capsule. The facet joints help in weight-bearing and preventing forward translation of the vertebral body. The cervical facet joints receive their nerve supply from nerves called the medial branches.
Localized tenderness over the joints, pain with rotation and tilting of the neck, “crunching or popping” sound with movement, pain radiating into the shoulder blade, shoulder or into the arm
Cervical spine X-rays. If there is radiating pain, an MR or CT may be indicated to better evaluate for foraminal stenosis (narrowing of the exiting hole through which the nerve exits the spinal canal and enters the arm). Nerve conduction studies may be helpful to evaluate for nerve related pain from the cervical spine or from a nerve entrapment in the arm.
A trial of physical therapy can help reduce muscular tightness and strain on the facet joints. Anti-inflammatories or local medicated creams may be helpful. If these measures fail, injections such as medial branch blocks, facet injections and radiofrequency ablation can be helpful. Surgery may be indicated in cases that continue to have radiating pain into the arm.