Unstable

Introduction The upper limb symptoms of cervical spondylosis are unstable. Cervical spondylosis, also known as cervical vertebra syndrome, is a general term for cervical osteoarthritis, proliferative cervical spondylitis, cervical nerve root syndrome, and cervical disc herniation. It is a disease based on degenerative pathological changes. Mainly due to long-term cervical vertebrae strain, bone hyperplasia, or disc herniation, ligament thickening, resulting in cervical spinal cord, nerve root or vertebral artery compression, a series of clinical syndromes of dysfunction. The manifestations of cervical disc degeneration and its secondary pathological changes, such as vertebral instability, loosening, nucleus pulposus or prolapse; spur formation, ligament hypertrophy and secondary spinal stenosis, etc., stimulated or oppressed Adjacent nerve roots, spinal cord, vertebral artery, and cervical sympathetic nerves, and cause a variety of symptoms and signs of the syndrome.

Cause

The basic pathological change of cervical spondylosis is the degeneration of the intervertebral disc. The cervical vertebra is located between the skull and the thorax. The cervical disc has frequent activities under load-bearing conditions and is susceptible to excessive micro-injury and strain.

The main pathological changes are: early cervical disc degeneration, decreased water content of the nucleus pulposus and fibrous swelling and thickening of the annulus fibrosis, followed by glassy degeneration and even rupture. After cervical disc degeneration, the pressure resistance and tensile strength are reduced. When subjected to the gravity of the skull and the pulling force of the muscles of the head and chest, the degenerated disc can undergo localized or extensive bulging to the periphery, narrowing the intervertebral disc space, overlapping the articular processes, dislocation, and the longitudinal diameter of the intervertebral foramen. Become smaller. As the traction resistance of the intervertebral disc becomes weaker, when the cervical vertebra moves, the stability between adjacent vertebrae decreases and the intervertebral instability occurs, the mobility between the vertebral bodies increases and the vertebral body has a slight slippage, which then appears Bone hyperplasia of the posterior facet joint, hook joint and lamina, degeneration of the ligamentum flavum and ligament, cartilage and ossification. Numbness, pain, movement and sensory disturbances on the shoulders, arms and back, hyperalgesia, touch inductance, numbness or ant feeling of the fingers, weak hands, heavy feelings, unstable objects, paralysis and other symptoms, upper limb muscle atrophy, Limited shoulder activity.

an examination

Related inspection

CT examination of intervertebral foramen compression test of bone and joint and soft tissue

1. Test of cervical spondylosis

The physical examination of cervical spondylosis, including:

(1) Pre-flexion neck test: The patient's neck is flexed forward and rotated to the left and right. If there is pain in the cervical vertebra, it indicates that the cervical facet joint has degenerative changes.

(2) Intervertebral foramen crush test (cylinder test): the patient's head is biased to the affected side. The examiner's left palm is placed on the top of the patient's head, and the right hand clenches the fist and rubs the left hand back. The patient has radiation pain or numbness, indicating that the force is downward. The transmission to the intervertebral foramen becomes smaller and has root damage. For those with severe root pain, the examiner can use the hands to overlap on the top of the head and pressurize under the pressure to induce or aggravate the symptoms. A positive compression test occurs when the patient's head is in the neutral or posterior position and is referred to as the Jackson indenter test.

(3) Brachial plexus pull test: The patient bows, the examiner holds the patient's head and neck with one hand, and the other hand holds the wrist of the affected limb, pushing and pulling in the opposite direction to see if the patient feels radiation pain or numbness. This is called the Eaten test. If the patient is forced to perform an internal rotation while pulling, it is called the Eaten strengthening test.

(4) Upper limb extension test: The examiner is placed on the shoulder of the healthy side to fix the other hand, and the other hand is held on the wrist of the patient, and gradually stretches backward and outward to increase the traction of the cervical nerve root. If there is radiation pain in the affected limb, it indicates that the cervical nerve root or brachial plexus is under pressure or damage.

2. X-ray inspection

Men over 40 years of age, about 90% of women over the age of 45 have spurs of the cervical vertebral body. Therefore, there is a change in the X-ray film, which does not necessarily have clinical symptoms. The X-ray findings related to cervical spondylosis are now described as follows:

(1) Orthotopic: Observe the presence or absence of pivotal joint dislocation, odontoid fracture or absence. Whether the seventh cervical transverse process is too long, with or without neck ribs. Whether the hook joint and the intervertebral space are widened or narrowed.

(2) Lateral position: 1 change in curvature The cervical vertebra is straight, the physiological protrusion disappears or the curve is reversed. 2 Abnormal activity in the cervical spine overextension and lateral position X-ray film, you can see the elasticity of the intervertebral disc has changed. 3 The epiphyseal vertebral body can produce osteophytes and ligament calcification in the vicinity of the intervertebral disc. 4 The intervertebral space narrowing the intervertebral disc can be thinned due to the nucleus pulposus, the water content of the intervertebral disc is reduced and the fibrosis is thinned, and the intervertebral space is narrowed on the X-ray film. 5 semi-dislocation and intervertebral foramen become small intervertebral disc degeneration, the stability between the vertebral bodies is low, the vertebral body often occurs subluxation, or called the vertebral. Six ligament calcification ligament calcification is one of the typical lesions of cervical spondylosis.

(3) Oblique position: The left and right oblique slices of the spine are mainly used to observe the size of the intervertebral foramen and the hyperplasia of the hook joint.

3. Electromyography

Electromyography of cervical spondylosis and cervical disc herniation can indicate that the nerve root is degenerated by long-term compression, thus losing the inhibition of the muscles that are innervated.

4. CT examination

CT has been used to diagnose spinal canal enlargement or bone destruction caused by posterior longitudinal ligament ossification, spinal stenosis, spinal cord tumor, etc., and bone density is measured to estimate the degree of osteoporosis. In addition, soft tissue and subarachnoid space inside and outside the dural sheath can be clearly seen due to the transverse tomographic image. Therefore, the correct diagnosis of disc herniation, neurofibromatosis, spinal cord or medullary cavity cavity has a certain value for the diagnosis and differential diagnosis of cervical spondylosis.

Differential diagnosis

Lumbar spondylosis

1 low back pain, leg pain, sciatica, coldness of the lower limbs, numbness, unstable walking, weakness, intermittent claudication.

2 spinal canal disease: muscle weakness, muscle atrophy, limb paralysis and other symptoms.

3 spinal nerve symptoms: the lower abdomen has a sense of belt, difficulty urinating, dysfunction of the stool and so on. Cough, pain, holding pain, bending back pain, abnormal bowel movements, abdominal banding. Low back pain sciatica aggravation after activity can not sit for a long time, can not stand for a long time, can not stand for a long time, can not be a posture pain can not fall asleep muscle atrophy in the pain area, severe or late emergence of two obstacles and spasm, in bed Can not, as the disease develops can gradually increase and become sustainable. Different types of warts can occur if left untreated.

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