Uncovertebral arthropathy is degeneration of the small joints on either side of the cervical vertebrae in your neck. These joints, sometimes called Luschka joints, exist only in the cervical spine and help guide neck movement and provide stability. As they wear down over time, bone spurs can form and narrow the openings where nerves exit the spine, potentially causing neck pain, arm pain, or neurological symptoms. The process begins as early as your 20s and becomes significantly more pronounced after age 40.
Where Uncovertebral Joints Are and What They Do
Each cervical vertebra from C3 to C7 has small bony projections on its upper edges called uncinate processes. These hook-shaped ridges meet the vertebra above to form the uncovertebral joints. Their job is twofold: they help stabilize the neck during movement and they limit how far vertebrae can slide side to side. They also form part of the back wall of the openings (foramina) where spinal nerve roots exit the spine. That positioning is precisely why problems with these joints can affect nearby nerves.
How the Degeneration Develops
Like any joint in the body, uncovertebral joints are subject to wear and tear. Over years of repetitive motion, the protective cartilage between the joint surfaces gradually thins. In response, the body lays down extra bone at the joint margins. These growths, called osteophytes or bone spurs, are driven by cells in the tissue lining the bone surface and triggered by growth factors that signal the body to reinforce the area. The result is a joint that becomes enlarged, stiff, and irregularly shaped.
The process tends to accelerate in middle age. CT imaging studies of healthy adults show that degeneration starts mildly in the 20s but progresses significantly between the 40s and 60s. After age 70, the changes become markedly worse. The C5-6 segment is consistently the most affected level, followed by C4-5 and C6-7. The upper cervical segments (C2-3 and C3-4) show relatively little change over a lifetime, likely because they bear less mechanical stress during everyday neck movements.
Symptoms You Might Notice
Mild uncovertebral arthropathy often causes no symptoms at all. Many people have some degree of joint degeneration on imaging without ever feeling it. When symptoms do appear, the most common is a stiff, aching neck that worsens with movement.
More noticeable problems arise when bone spurs grow large enough to compress a nerve root, a condition called cervical radiculopathy. This produces a sharp or electric pain that starts in the neck and shoots into the shoulder, arm, or hand, following the path of the affected nerve. The pain typically appears on one side and gets worse when you tilt or rotate your head toward the painful side, extend your neck backward, or raise your arm overhead.
Beyond pain, nerve compression can cause tingling, numbness, or a pins-and-needles sensation in the arm or fingers. You may notice weakness in certain muscles, like difficulty gripping objects or raising your arm. These symptoms tend to follow predictable patterns depending on which nerve root is affected. A pinched nerve at C5-6, for instance, often causes weakness in the biceps and tingling along the outer forearm and thumb.
How It Gets Diagnosed
Uncovertebral arthropathy is almost always identified on imaging, often as an incidental finding on a scan ordered for neck pain. Standard X-rays can reveal joint space narrowing and obvious bone spurs. CT scans provide more detail and allow three-dimensional reconstruction of the joints, making it easier to grade the severity. A modified version of the Kellgren and Lawrence classification is sometimes used, ranging from Grade 0 (normal, symmetrical joints) to higher grades reflecting progressive narrowing and osteophyte formation.
MRI is useful for evaluating how the degeneration affects soft tissues, particularly whether bone spurs are compressing nerve roots or the spinal cord. However, MRI doesn’t reconstruct the bony anatomy of these joints as precisely as CT. There is no universally agreed-upon grading system for uncovertebral joint degeneration, so reports can vary in how they describe severity.
Why the Nerve Openings Narrow
The uncovertebral joints sit right along the lateral border of the neural foramina, the bony tunnels that nerve roots pass through on their way out of the spine. When bone spurs enlarge these joints, they encroach directly into the foramen from the side. This lateral narrowing compresses the nerve root and its surrounding tissue, including the highly sensitive dorsal root ganglion, a cluster of nerve cell bodies near the exit point. That compression is what produces the radiating arm pain and neurological symptoms characteristic of radiculopathy.
This particular pattern of narrowing matters for treatment decisions. Because the compression comes from the front and side of the foramen rather than from behind, approaches that only address the back of the spine may not fully relieve the problem.
Conservative Treatment Options
Most people with uncovertebral arthropathy are managed without surgery. Initial treatment focuses on reducing pain, restoring mobility, and building strength in the muscles that support the neck. A combination of physical therapy and exercise is a mainstay. Research comparing different approaches found that manual physical therapy paired with targeted exercise was more effective than simple advice and gentle motion exercises for chronic mechanical neck pain.
Self-management strategies also play a meaningful role. A study of 156 patients with neck pain found that a multimodal approach combining self-management with coping skills training outperformed individualized physical therapy alone over a two-year follow-up. In practice, this means learning to modify daily activities, manage flare-ups with heat or ice, and maintain a consistent exercise routine. Over-the-counter anti-inflammatory medications can help during acute episodes.
For persistent pain that doesn’t respond to these measures, injection-based treatments such as cervical nerve root blocks or facet joint injections may be considered to reduce inflammation around the compressed nerve.
When Surgery Becomes Necessary
Surgery is reserved for cases where nerve compression causes progressive weakness, significant persistent pain despite months of conservative treatment, or signs of spinal cord compression. The most common procedure is an anterior cervical discectomy and fusion, performed from the front of the neck. During this surgery, the damaged disc is removed and the overgrown bone spurs along the uncovertebral joints are carefully trimmed to widen the nerve opening.
In cases where bone spur regrowth causes recurrent symptoms, a more aggressive removal of the uncinate process itself may be needed. This is technically demanding because the vertebral artery runs just beside these joints. The goal is to fully decompress the nerve root by removing the source of the lateral narrowing. Recovery from cervical fusion typically involves several weeks of restricted activity followed by gradual rehabilitation, with most patients noticing improvement in arm pain relatively quickly while neck stiffness resolves more slowly over months.