Degenerative disease (Arthritis)

Arthritis, like other degenerative diseases occurs when the joints in your spine and/or the rest of the body begins to wear away.

This condition is most common in older adults and can cause symptomatic pain in the localized affected area either the lower back, neck, wrist, shoulder, etc. It leads to anatomical changes and loss of normal function of joints in the spine. It may result from abnormal mechanical forces (e.g. occupational stress, obesity) or previous joint stress (trauma, rheumatoid arthritis). Degeneration can occur in any part of the human body joints e.g. spine, shoulder, wrist, etc.

This condition is most common in older adults and can cause symptomatic pain in the localized affected area either the lower back, neck, wrist, shoulder, etc. It leads to anatomical changes and loss of normal function of joints in the spine. It may result from abnormal mechanical forces (e.g. occupational stress, obesity) or previous joint stress (trauma, rheumatoid arthritis). Degeneration can occur in any part of the human body joints e.g. spine, shoulder, wrist, etc. To be specific in the spine, it can be an involvement of disc (degenerative disc disease), facet (facet arthrosis) and uncinate processes (uncinate arthrosis). Degeneration can be asymptomatic, but it can cause local pain to the area. It usually occurs insidiously with a history of repetitive stress and/or neck trauma.

Signs and Symptoms

Patients usually mention that long term of inactivity, movement or cold weather makes the condition worse. Lifting or adding stress also worsens the condition. Heat and rest help to alleviates the symptoms. It is usually common in the age of over 50 years old causing dull, achy and stiffness after period of inactivity.

In this condition, an individual can go through postural changes e.g. loss of the curve or increase in thoracic (upper back & mid back) curve. The motion of the spine can be restricted due to the less mobility in the joint. Orthopedic test can also be performed to confirm the diagnosis which may include Cervical distraction, Cervical foraminal compression, Jackson’s, Maximum cervical compression test, modified Spurling’s test and shoulder depression test which may lead to local neck pain indicating degeneration in the cervical spine.

Standing kemp’s test and goldwait’s test may indicate local pain in the back which indicates lumbar and lumbar spinal degenerative disease.

Degeneration can also occur in other part of the body. It typically affects the shoulder, wrist, ankle, knee and hip joint destroying the smooth outer covering of bone. During movement, the bones of the joint rub against each other, causing pain. There are five major types of degeneration/arthritis affecting the extremity joints.

1. Rheumatoid arthritis: a chronic disease that attacks multiple joints throughout the body. It is symmetrical, meaning that it usually affects the same joint on both sides of the body e.g. both wrists, feet and shoulder. Rheumatoid arthritis is an autoimmune disease. This means that the immune system attacks its own tissues. In RA, the defenses that protect the body from infection instead damage normal tissue (such as cartilage and ligaments) and soften bone.

2. Post traumatic arthritis is a form of osteoarthritis that develops after an injury, such as a fracture or dislocation of the shoulder or other joint.

3. Rotator cuff tear arthropathy (specific for shoulder): Arthritis can also develop after a large, long-standing rotator cuff tendon tear. The torn rotator cuff can no longer hold the head of the humerus in the glenoid socket, and the humerus can move upward and rub against the acromion. This can damage the surfaces of the bones, causing arthritis to develop.

4. Osteoarthritis: wear-and-tear” arthritis, osteoarthritis is a condition that destroys the smooth outer covering (articular cartilage) of bone. As the articular cartilage wears away, it becomes frayed and rough, and the protective space between the bones decreases.

5. Avascular necrosis: Avascular necrosis (AVN) is a painful condition that occurs when the blood supply to the bone is disrupted. Avascular necrosis develops in stages. As it progresses, the dead bone gradually collapses, which damages the articular cartilage covering the bone and leads to arthritis.

Symptoms:

The most common symptoms of arthritis/degeneration include is pain. As the disease progresses, any movement of the joint e.g. neck, shoulder, knee and hip movement causes pain. Night pain is also common which may affect the sleep. Other symptoms may include limited range of motion affecting their daily lifestyle. A grinding, clicking or snapping sound may also be heard from the joint.

Diagnosis:

A physical examination will be performed where your health Practioner will look for any weakness, tenderness signs of previous injuries, perform thorough orthopedics and neurological assessment. In terms of radiographic imaging, Degeneration can be diagnosed with the help of x-rays. Osteophytes (extra bone growth can be seen around each vertebra end plate). There is reduction in the disc height in between each vertebra, the joints get blunt and the ligaments starts to thicken in the spine. These features indicate the presence of degeneration in the spine. Medical managements may include NSAID’s, facet joint infection, physical therapy, occupational therapy, lose weight, surgery and stem cell therapy.

Management:

Initial treatment usually involves rest or change in activities. Physical therapy exercises may improve the range of motion of the spine and extremities. Dietary supplements such as glucosamine and chondroitin sulfate may help relieve pain. Surgical treatment may also be considered if the degeneration causes disability and severe pain is experienced. These may include Arthroscopy, steroid injection etc.

In terms of Chiropractic management, there are no absolute restrictions to the treatment provided. Your chiropractor will moderate the technique and force according to your (patient) tolerance. Chiropractor focus on the relationship between the spine and nervous system. Since spine can get affected by the daily physical repetitive stresses, it may also alter the biomechanics of the spinal and extraspinal structures such as the cranial or extremities bones, can lead to the altered neural signal being sent to the spine or vice- versa.

This altered state of the spine can interfere with the neurological function, affecting homeostatic balance which may symptomatically and adversely affect the individual’s health. Adjusting the spine or correcting the biomechanics helps to restore and improve the overall function. It helps to relieve the pain and increase the mobility in the joint. Chiropractic care is not limited to any individual with any age and condition present. If you or anybody you know you may get benefit from Chiropractic care, get in touch with your nearest Chiropractor and start the journey towards the healthy living.