What are the signs and symptoms of rheumatoid arthritis (RA) of the cervical spine?

Updated: Aug 13, 2019
  • Author: Steven R Garfin, MD; Chief Editor: Jeffrey A Goldstein, MD  more...
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Answer

Answer

Compression of the C2 sensory fibers supplying the nucleus of the spinal trigeminal tract can cause facial pain. Compression of the C2 sensory fibers supplying the greater auricular nerve may result in ear pain. Occipital neuralgia results from compression of the C2 sensory fibers supplying the greater occipital nerve.

A history of myelopathic symptoms should be sought carefully. Patients may experience weakness, decreased endurance, gait difficulty, paresthesias of the hands, and loss of fine dexterity.  Limb paresthesias and bowel and/or bladder disturbance may develop.

Vertebrobasilar insufficiency may be found, particularly in patients with atlantoaxial instability (AAI). Complaints may include vertigo, loss of equilibrium, visual disturbances, tinnitus, and dysphagia. Similar symptomatology can also be caused by mechanical compression of the brainstem.

In some patients with AAI, neck flexion produces crepitation or a sensation of the head “falling forward”. This may be reproduced on physical examination, in which a palpable “clunk" may be appreciated on neck flexion, [37]  Neck motion may also elicit shocklike sensations through the torso or into the extremities (ie, Lhermitte sign).


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