Cervical spondylosis (neck arthritis): symptoms, treatment and warning signs

The NHS lists the symptoms of cervical spondylosis as neck and shoulder pain or stiffness that can come and go, and headaches that often start at the back of the neck. Many people with the condition have no symptoms at all.

Arthritis UK describes other neck symptoms that are not specific to spondylosis but commonly seen: pain and stiffness, which may extend to the shoulder or upper chest, tension headaches, numbness or tingling in the arm, clicking or grating noises, and muscle spasms. If you have pain, tingling, numbness or weakness in your arms or legs, see a healthcare professional.

The NHS suggests gentle neck exercises, improving your posture and taking painkillers such as paracetamol and ibuprofen to ease pain and stiffness. A pharmacist may be able to recommend stronger painkillers if you need them. Arthritis UK says that with the right exercises, advice from a doctor and attention to general wellbeing, symptoms are more likely to improve.

For neck pain in general the NHS also suggests the following, and advises not wearing a neck collar because it is better to keep the neck moving unless a doctor tells you otherwise.

• Ibuprofen gel on the neck and a low, firm pillow.

• A pack of frozen peas wrapped in a tea towel for 5 minutes, 3 times a day.

• A hot water bottle wrapped in a tea towel for 20 minutes, 2 to 3 times a day.

• Do not do anything that could be dangerous because you cannot move your neck freely, such as driving or cycling.

The NHS says treatment depends on how bad your symptoms are. You may be given exercises and advised to carry on with your usual activities as much as possible. A muscle relaxant or other medicine may be prescribed if the pain has been coming and going for a long time. It usually takes a few weeks for treatment to work, although the pain and stiffness can come back.

If symptoms do not improve in a few weeks you may need physiotherapy. The NHS notes waiting times for NHS physiotherapy can be long, and you can also get physiotherapy privately through a registered physiotherapist. In many areas you can refer yourself to NHS community musculoskeletal (MSK) services without a GP referral.

Surgery is only considered if a nerve is being pinched by a slipped disc or bone (cervical radiculopathy) or there is a problem with the spinal cord (cervical myelopathy). The NHS says surgery is not always a cure, but it may stop your symptoms getting worse.

The NHS says to ask for an urgent GP appointment or get help from NHS 111 if you have severe neck pain that starts suddenly or is getting worse quickly, heaviness or weakness in your arms or legs, pins and needles in an arm as well as neck pain, or arm pain between your shoulder blades.

It says to call 999 if you have any of these, as they can be signs of a medical emergency:

• New problems walking.

• Loss of bladder or bowel control.

• Sudden lack of co-ordination, for example with tasks like buttoning a shirt.

• Somebody's face drooping on one side.

• A person who cannot lift both arms up and keep them there.

• Difficulty speaking, with slurred or garbled speech.

The NHS describes cervical spondylosis as a common condition that can cause neck and shoulder pain, often in people over 40. It happens when ageing causes wear and tear to the bones in the spine and the soft cushions of tissue (discs) in the neck.

Arthritis UK gives more detail: small lumps of new bone called osteophytes grow at the edges of the vertebrae and the facet joints, and these changes can be seen on X-rays. Spondylosis may increase the risk of spells of neck pain, but because neck pain tends to come and go over several weeks, it is not usually possible to identify spondylosis as the direct cause. It should not be confused with ankylosing spondylitis, which is an inflammatory condition.

Many people over 40 get cervical spondylosis as part of getting older. The NHS says you may be more likely to get it at any age if you have previously had a neck injury or have a family history of the condition.

Not all neck pain is spondylosis. The NHS lists the most common causes of neck pain as the neck becoming locked in an awkward position while sleeping, bad posture such as sitting at a desk for a long time, a pinched nerve, and an injury such as whiplash. Arthritis UK adds worry or stress, a sprain or strain, and a flare-up of cervical spondylosis.

The NHS says to see a GP if neck pain or stiffness does not go away after a few weeks, if neck pain is worse when you move, if painkillers have not worked, or if you are worried. At the appointment a health professional will examine your neck and shoulders, may test your reflexes and watch you walk, and depending on your symptoms may arrange X-rays or scans.

NICE Clinical Knowledge Summaries describes cervical radiculopathy as pain, weakness or numbness in one or both arms from compression or injury of a nerve root in the neck, most commonly caused by degenerative changes such as disc herniation and spondylosis. It says around 88% of people improve within four weeks with non-operative management.

Arthritis UK explains that, rarely, disc bulges and osteophytes can narrow the spinal canal (spinal stenosis), which can affect the spinal cord and cause weakness in the arms and legs, a condition known as myelopathy. It says symptoms associated with myelopathy and stenosis can progress, which is why the warning signs above need prompt assessment.

On the NHS, neck pain is usually managed by your GP or by a community MSK service you may be able to self-refer to, with physiotherapy, and referral to a spinal specialist if a nerve or the spinal cord is affected. Urgent warning signs are dealt with through NHS 111, A&E or 999.

Private physiotherapy, spinal consultations and scans are also available. Ask what the scan is expected to change, since changes of spondylosis are common and often unrelated to pain, and ask how progress and any warning signs will be reviewed.