Treatment decision6 min read
Which symptoms require assessment in neck arthritis?
Cervical spondylosis is very common and mostly runs an uneventful course. In a small number of patients, however, advancing structural change can affect a nerve root or the spinal cord. Distinguishing the two matters.
The expected picture
Morning stiffness, restricted neck movement and tension building through the day are expected components of this picture.
Pain felt at the back of the neck and over the shoulders that eases with rest also belongs here. Fluctuation with weather is normal.
Clicking during movement, without accompanying pain and restriction, is not meaningful and does not by itself require assessment.
Symptoms suggesting nerve root compression
Pain starting in the neck and spreading along the shoulder and arm, below the elbow, suggests nerve root compression and is assessed separately.
Where numbness, tingling or electric sensations in the fingers accompany it, assessment is widened. Which finger is affected indicates the level involved.
Objective weakness in the arm or hand, dropping objects and reduced grip should be assessed without delay. This indicates the picture is progressing.
Symptoms suggesting cord compression
Unsteadiness when walking, stiffness in the legs and a sense of insecurity when stepping require urgent assessment. These suggest cervical myelopathy.
Loss of fine hand dexterity is a clear warning: buttoning, picking up coins or writing become difficult. It can appear without pain.
Changes in bladder or bowel control are not suitable for waiting. Where these are present, the imaging decision is taken without delay and management is entirely different.
Key points
- Morning stiffness and restricted movement are expected findings.
- Pain below the elbow and finger numbness require assessment.
- Objective arm weakness should be assessed without delay.
- Unsteady walking and loss of hand dexterity are urgent findings.
- Changes in bladder control are not suitable for waiting.
Frequently asked questions
Can spondylosis cause paralysis?
This is very rare. Untreated severe cord compression can lead to neurological loss, which is why gait and hand dexterity symptoms are assessed early. The great majority of spondylosis never reaches that point.
Should I have an MRI?
Usually not, absent neurological signs, and it does not change treatment. Where there are arm symptoms, weakness or gait change, the imaging decision is taken without delay.
How often is review needed?
Routine review is not needed in patients with stable symptoms. Assessment is repeated when symptoms change markedly, a new referral pattern appears, or weakness develops.
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This content is for information only and does not replace medical diagnosis or treatment. Response to treatment varies between individuals. Please consult a healthcare professional about your symptoms.