UncoVertebral Joint Luschka

Tingling in arms and hands

Keywords; uncovertebral joint luschka, whiplash.

Paresthesias in the upper limb, often with a deep radiating ache, and a whole spectrum of conditions like frozen shoulder, rotator cuff syndrome, and carpal tunnel are frequent complaints in the chiropractic clinics.

In fact, I would go as far as to say that there is barely a chiropractor in the whole world who won't be faced with at least one patient every day suffering from one of these syndromes, directly related to uncovertebral hypertrophy.

The origin of them lies very frequently in the so called UncoVertebral Joints, named after a German anatomist, Hubert Luschka more than 150 years ago.

In most of the spine there are three joints between the vertebrae:

  • One disc
  • Two facet

UncoVertebral Joint Luschka

However, in the lower cervical spine, between the lowermost five bones C3, C4, C5, C6 and C7 are four extra pairs of joints that allow forward flexion and rotation of the neck, whilst limiting lateral translation and lateral flexion: The movements that occur in a side-on (broadside, T-bone collision) whiplash. Or, that occur if your head and neck were turned during a rear-end collision.

These four pairs of joints have been given various names: Joints of Luschka, UncoVertebral joints, paracentric joints, neurocentric joints. And others.

The Uncus or Uncinate process

At the lateral edge of the vertebral body, small ridges of bone jut upwards forming a joint between the uncinate and the vertebral body above. Anatomists argue about the true nature of the UncoVertebral Joint Luschka but on the whole there seems agreement that they are synovial joints.

The inner (medial) surface of the uncus is covered with conventional hyaline cartilage as is the corresponding undersurface of the side of the vertebral body where a concave area is also lined with cartilage. The joint of Luschka. It is covered with a synovial membrane which contains the synovial fluid which brings nutrients to the hyaline cartilage lining the joint surfaces.

Clinical significance

The term "neurocentric" joint is often used today because of the important relationship between the Joint of Luschka and the mixed nerve root, containing both incoming sensory input, and outgoing motor nerves.

Hence, any uncovertebral hypertrophy (read arthritis) can cause both tingling in arms and hands, arm pain, and weakness in the arms and hands.

The Luschka joints, in yellow, lie just in front, anteriorally, and inside, medially, of the nerve root, in blue.

Equally, the joint could be called a vasculo centric joint, though it isn't. The uncovertebral joint luschka lies just behind, posteriorally and medial to the vertebral artery, in red,  supplying oxygenated blood to the posterior part of the brain. Thus the uncovertebral joint lushka has also the potential to cause vascular brain symptoms such as vertigo.

The disc, the vertebral body, together with the Joints of Luschka, form the anterior wall of the foramen through which the spinal nerve passes. The uncus in fact gives some protection to the nerve root from any herniation of the disc.

In theory, the close relationship between the UncoVertebral Joint Luschka and the Vertebral artery might have some clinical significance for the Chiropractor, as it certainly does for the spinal surgeon. 1/1,000 neck operations end in death often because of this vital relationship between the vertebral artery and the Joint of of Luschka.

However, for the chiropractor, it appears to be of little concern. Millions of cervical spines are manipulated every day, many with UncoVertebral Joint arthrosis with no effect on the Vertebral artery.

Those extremely rare (1/ 6,000,000) cases where Stroke Chiropractic do occur appear to be rather to do with the tortuous course of the Vertebral artery in the upper cervical spine.


Cervical Acceleration Deceleration (CAD) injuries of the cervical spine occur in MVA's but obviously in many other ways. Falls off horses, down the stairs, diving into shallow water and in many sports such as rugby and American football.

Most of the three million MVA whiplashes in the USA every year would cause trauma to the ligaments, tendons and muscles in the neck. However, a very significant number injure the brainstem and the spinal cord too.

Also, whiplash from a T-bone accident may injure or fracture the uncinate process as the cervical spine is forcibly moved into lateral flexion, exactly the movement that the Uncovertebral Joint Luschka serves to prevent. Arthrosis develops, reducing the size of the foramen and irritating or frankly pinching the nerve root: pain and tingling in the arms and hands ...

Test yourself for a pinched nerve

Arm pain

That part of the spine where the UncoVertebral Joint Luschka is found (C3-C7) is sometimes called the "cervico-brachial" spine, "brachial" meaning to do with the arm. Injury to this area "commonly refers pain to the arm."

This is because UncoVertebral hypertrophy / arthritis compromises the "inter vertebral foramen", or IVF, through which the nerve must pass on its way to the arm.

"Pathology in the lower cervial spine can lead to neck pain alone, arm pain alone,  or both neck and arm pain, headache, tingling in arms and hands, altered "myotomes" (ie weakness in specific muscles), restricted movement of the neck, and "radicular" signs. Those to do with a pinched nerve root."

Orthopaedic Physical Assessment (Magee).


In the practice, chiropractors are fairly frequently faced with patients who have begun to manipulate their own necks. This bizarre and dangerous procedure usually begins after some trauma to the cervical spine, perhaps a whiplash, which limits the movement between the vertebrae.

Researchers have pointed out that the hyaline cartilage lining all joints is utterly dependent on the movement of the joint for normal nutrition. Decreased range of motion leads to a dearth of cartilage nutrients and oxygen, and a build up of waste products.

In white mice, immobilisation arthritis has been shown to begin within thirteen hours of a joint being immobilised.

This progressive insidious early arthritis leads to vague symptoms of discomfort in the neck emanating from noci ceptors within the UncoVertebral joint of Luschka. Normally, movement of the neck stimulates mechano receptors within the joints, which give rise to a cascade of neurological impulses into the spinal cord, inhibiting the impulses from nociceptors. But, in the presence of joint fixation, the impulses from these nociceptors are in the majority, sending information to the sensory cortex that all is not well in the state of Denmark.

The normal reaction is to turn the neck, moving through the ranges of motion until the fixated joint moves, albeit perhaps less than normal movement due to the injury. The mechanoreceptors fire up, inhibiting the sense of discomfort, even pain, originating from the cartilage starved of nutrients. The synovial fluids in the joint begin to slosh about restoring the cartilage.

One might also go for a massage, start a tai chi or aerobics class, or even consult a chiropractor. Anything that stimulates movement in the offending joint and associated muscles.

But in self manipulators, they discover that crack or two brings relief, which it does but there are problems. Usually the movement induced in the UncoVertebral joint of Luschka is partial, so the manoeuvre has to be repeated an hour or two later; and again, up to ten or more times a day.

In addition, the self manipulation involves movements of lateral flexion and translation in the spine, something the uncovertebral joints of Luschka  are designed to limit. Just watch someone who cracks their own neck; it's horrific and very dangerous.

Furthermore, during a chiropractic adjustment, the joint is distracted to prevent the cartilage violently striking its mate. Self manipulators are unable to do that.

Just how much manipulation of a particular joint is healthy, and how much is excessive, has not been determined; but as a rule of thumb, I personally believe, based entirely on opinion, that more than twenty five adjustments of one particular joint in a year is too much.

Self poppers often achieve that in less than a week. Just as rebound headache is caused by overuse of medication, so too much manipulation, particularly cracking your own neck, actually certainly contributes to the problem.

Just ask anyone who has been manipulating their own neck for five or more years. Arm pain and tingling in arms and hands always begins, and is often severe.

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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.

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