1. Cervical Spondylosis (Degenerative Disc Disease)

2. Normal Anatomy Intervertebral disc – Annulus fibrosus – Nucleus pulposus Gel type substance Shock absorber

3. Pathophysiology Disc degenerates (normal process) – Water loss Changes height of IVD Changes orientation of joints Leads to instability or increase shear stress Increase shear stress irritates facet joints leading to OA Increased stress and strain on soft tissue

4. Pathophysiology Osteophytes form to in response to increase facet apposition and instability Pain is not caused by the degeneration itself – Soft tissue and joint irritation source of nociceptive input

5. Mechanism Of Injury Insidious onset – Normal change with ageing NEVER traumatic History of traumatic sports can accelerate degeneration

6. Associated Pathologies Osteoarthritis Stenosis Disc Herniation Radiculopathy

7. Subjective 60% of people over 45, 85% of people over 65 Insidious onset pain Intermittent neck and shoulder pain Stiffness first thing in the morning Occasional night pain Worse with movement (small amounts can ease symptoms) Pain sitting for long periods Pain with rotations, extension or sustained flexion +/- paraesthesia

8. Objective Instability catch from flexion to neutral (dependent on stage) Pain with extension Reduced side flexion and rotation (capsular pattern) Reduced Thoracic ROM Poor Scapular stabilisation Pain and stiffness joint play Tenderness palpation soft tissue

9. Special Tests Instability Catch Capsular pattern

10. Further Investigation X-ray MRI – Rule out serious pathology

11. General Management Directed at Soft Tissue and Joint Stiffness Degeneration of IVD is non reversible Management of symptoms rather than a cure Instability vs Fusion ?Long term maintenance Emphasis on self management

12. Conservative - Management Pain Relief – NSAID’s, Ice or Heat, Massage Restore ROM – Cervical AND Thoracic – Cervical Rotation, Extension, Thoracic Extension and Rotation – Soft Tissue, Joint Mobilisations Restore Normal Muscle Activation – Deep cervical flexors, Deep cervical Extensors, Scapular upward rotators and posterior tilt Restore Normal Dynamic Stability and Proprioception

13. Plan B - Management Only considered for neurological compromise Facet Injections rare due to high risk Fusion rarely completed