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CERVICAL SPONDYLOSIS : Its Multifaceted Presentation
J C Patel*, S V Joshi **, H L Dhar ***
*Hon. Physician; "Technical Officer; ***Director; Research Centre, Bombay Hospital Trust, Mumbai - 400 020.
General population attending OPD with varied symptoms, spondylosis was detected in 1.25 % (n=40).
In this series, we noticed a diagnostic spot of stiff tender node on one side of the neck portion of trapezeus in 80 per cent of cases and named it as BH node.
INTRODUCTION
The aim of this presentation is to create awareness among practising physicians including specialists, the presence of cervical spondylosis in patients with apparently simple complaints such as chest pain which presents as an associated variety of symptoms ranging from CNS to GI tract.
Cervical spondylosis is far more prevalent than realised by an average Indian physician and the sufferers present with wide ranging symptoms affecting areas such as head, abdomen, front and from lower front chest or the mid thoracic region, ne or both arms, forearm or shoulders more especially on the area of trapezeus, back of the neck, elbow or fingers, such as small finger, two fingers or thumb of one side only. Few had pain, tingling numbness, cramps in the fingers and paraesthesia. Hence such symptoms take the patients to different disciplines of medicine viz. gastroenterologists, rheumatologists besides family physician.
RESULTS
Records of 3192 cases attending the weekly OPD of the Bombay Hospital of one of the authors were analysed, of which 40 cases (24 females andan 16 males) i.e. (1.25%) were diagnosed as cases of cervical spondylosis. The age ranged from 16 years to 72 years. Nowadays pain in chest, is usually associated with cardiac disorder hence some of them had approached the cardiologist who had advised for X-ray and electrocardiogram which were within normal limits. One of them who had pain in upper left pectoral region radiating to neck, and to the left arm even had undergone coronary angiography which turned out to be normal. Even though he was relieved of the fear of having back of the chest, pain in pectoral area ranging dreaded heart disease, pain persisted and attendedour OPD for relief of persistent symptom. On investigation, he had cervical spondylosis and was relieved by the treatment mentioned below.
One of the important findings of this study is the spot of small stiff tender nodular area on one or other trapezeus commonly at the junction of cervi cal and shoulder part of trapezeus muscles considered as a sign of spondylosis was detected in neurologists, cardiologists, chest specialists and nearly 80% of cases with cervical spondylosis.This finding was used as the important sign in the diagnosis of cervical spondylosis in our study. We consider that it should be named as "Bombay Hospital Tender node" (BH Node) which is a characteristic in diagnosis of cervical spondylosis.
We suggest physicians to be aware of the presence of this node where cervical spondylosis is suspected.
Radiological reports showed lesions of spandylosis in only 79% while 21% were reported to be normal even though clinical symptoms including presence of tender node suggested cervical spon-dylosis. It is possible that, radiological findings may not be positive and changes could be minor in early stages of the disease and may require further progression of the disease for the radiological evidence of diagnosis. However, loss of curvature the spine - as a positive finding was present and considered as an early radiological sign in seven and cases.
Blood pressure, a routine examination of all the patients of cevical spondylosis was within normal limits except in two cases, one male (47 years) had BP 160/120 and one female (72 years) with BP of 160/90, while one of the cases, 40 years old female had low BP (90/70).
Some detailed description of cases which had gone to other departments before taming to us is given below:
CASE 1
Thirty nine year male presented with complaint of pain in chest in both upper pectoral region with a history of cough; had gone to chest OPD. Chest X-ray revealed no anbormality. He was referred to medical ORD for relief of pain. On our interogations, he complained of pain in shoulder and right arm. He had tender BH node on shoulder position of Irapezeus. X-ray of cervical spine confirmed the presence of cervical spondylosis. Patient became symptom free with physiotherapy. This case was referred to medical OPD by respiratory department.
CASE 2
Forty seven year male came to medical outpatient department with a complaint of flatulence and pain in epigastrium along the lower chest on both sides. He was treated by gastroenterologist but with no relief. On further questioning, he mentioned about pain in upper chest, in addition to bilateral lower chest shoulder and back of chest. He was diagnosed by us as a case of cervical spondylosis and was relieved by analgesics and physiotherapy.
CASE 3
Thirty year male wits, paraesct,esia in left thumb and occasional weakness in hand for which he was treated neurophysician with vitamins including vitamin B-12 with little relief. However, paraesthesia persisted. This patient also was labelled by us as a case of cervical spondylosis at sieved by analgesics and physiotherapy.
CASE 4
Nowadays there is increasing prevalence of heart disease in of our country. Patients with these pain, visit a cardiolologist for the treatment which is planned with the help of etectracardiogram coronary angiography however, in this patient( 53 year male), these findings were within normal limits. A s the pain persisted, this patient come to us. Detailed history cervical spine and BH node were helpful in diagnosis of cervical spondylosis. He was relieved by physiotheraphy and analgesics.
DISCUSSION
Prevalence of cervical spondylosis of radiculopathy is not ordinarily considered for chest pain and its incidence is only 1.25% in our 3192 OPD patients. However, it is common and present itself with varied symptoms suggesting disease of various organs of upper half of for which persons go for treatment to their family in physician, sometimes referred to the specialists since some of the symptoms are frightening to suggest serious diseases of heart and Chest besides suggesting symptoms of GI tract and neirological disorder. The awareness is required of Cervical SPOndylOSis, its different and multifaceted form. Important sign we have noticed is a finding of tender stiff node on the trapezeus (horizontal part) of shoulder. We consider it as diagnostic even when the X-ray findinds are in conclusive, and named "BH Node" on shoulder part of trapezeus.
Back ground symptoms caused by cevical spondylosis are varied which may lefamily physician, chest specialists, neurologists or even gastroenterologist.Details of history of pain, its origin and radiation are vague and do not occur at the, one and same time and therefore cases of cervical spondylosis have been seen by many speciallists. Careful and frequent deailed questioning soemtimes bring out a long history of insignificant symptoms needing correlation and the diagnosis of cervical spondylosis.
Person suffering from cervical spondylosis having varied symptoms in upper half of chest, in epigastrium,neck and arms simulates many varied diseases which should be excluded before being facilities. Symptoms are intermittent with periods of relief lasting from few days to some years. Cervical spondylasis is considered a disease of old age in the text books while our report has shown that it is present at different ages.
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