Dowager hump is a local accumulation of adipose tissue in the area of the lower cervical and upper thoracic vertebrae. Externally, it is manifested by stooping, hunched figure. However, often the dowager hump is not only an aesthetic problem, it can be accompanied by pain in the shoulder girdle, cephalgia, clicks and crunches when turning the head, sleep and memory disorders. It is diagnosed during a physical examination, to clarify the condition of the spine, radiography or CT of the cervical spine, densitometry is performed. Treatment mainly includes physical therapy, massage, manual and shock wave therapy. It is possible to remove the formation with the help of thermolifting, liposuction.
ICD 10
M40.1 Other secondary kyphoses
General information
Dowager hump (climacteric hill) is a fat cushion localized under the skin on the back of the neck. It is a dense roller, which in profile looks like a hump in the neck-collar zone. Dowager hump has a hormone-dependent nature, it is formed mainly in women of premenopausal and menopausal age. Statistics on the frequency of this condition are not provided, however, it is known that fat “withers” occur more often in overweight women. In men, such a formation on the neck is called a “bull” or “bison” hump.
Causes
In most cases, behavioral factors lead to the development of a dowager hump. First of all, this is a sedentary lifestyle, chronic tension of the neck and back muscles during prolonged stay in a monotonous static pose (especially when working at a PC, using gadgets). All this weakens the muscular corset of the shoulder girdle, leads to the proliferation of connective and adipose tissue. Additional factors aggravating pathological changes are:
- Heredity. A fatty growth in the area of the VII cervical vertebra may be a genetic feature of women of different generations in the same family. In this case, it is not the “withers” itself that is inherited, but the features of the endocrine regulation of fat metabolism.
- Diseases of the spine. Osteoporosis, osteochondrosis of the cervical spine, spinal injuries are of the greatest importance for the formation of the dowager hump. Violation of mineral metabolism, dystrophic changes, damage to muscles and vertebrae lead to a change in posture, deformation of the spine, which entails the formation of a fat roller.
- Endocrine disorders. A sharp decrease in the production of estrogens during menopause leads to the predominant influence of testosterone and the deposition of adipose tissue in the male type – in the back, neck, shoulder girdle. The massive upper torso with a dowager hump is characteristic of patients with Itsenko-Cushing’s disease. Other contributing factors are obesity, taking hormonal drugs.
Risk factors
There are certain conditions in the presence of which the risk of the formation of a dowager hump becomes significantly higher. These include:
- gender – female;
- age over 40-45 years;
- features of professional activity that require a long stay in the same position with a bent back and lowered head (accountants, office workers, seamstresses, etc.);
- overweight.
Pathogenesis
Dowager hump is a multi-stage pathology that goes through the stages of muscle spasm, proliferation of fatty and fibrous tissue, spondyloarthrosis. At the first stage, due to incorrect posture, there is a prolonged spasm of the shoulder girdle muscles. The muscular corset ceases to serve as a “case” for the spine. Intervertebral ligaments and discs lose their elasticity, cervical lordosis straightens, which creates conditions for the formation of withers in this place.
Further static loads and stress contribute to the disruption of microcirculation and lymph outflow in this area. In such conditions, muscular dystrophy gradually develops, connective tissue grows instead of muscles, fat deposits accumulate in the shoulder girdle area. At first, the dowager hump causes only cosmetic inconvenience. However, in the later stages, it is joined by pain and vascular syndromes.
Symptoms of dowager hump
The fat hump in the lower part of the neck is formed gradually. At first, it is a small seal that does not deform the upper back much. Gradually, the withers increase, giving the figure a bent, stooped appearance. In the future, there are pains in the cervical region, a feeling of stiffness and tension, numbness of the back of the head. When you turn your head, there are clicks and crunches.
Musculotonic syndrome causes deterioration of blood flow in the cervical spine, this negatively affects the blood circulation of the brain as a whole. Vertebro-basilar insufficiency develops, which is accompanied by attacks of dizziness, constant headache, fluctuations in blood pressure, fatigue, drowsiness, memory impairment.
Complications
Chronic insufficiency of cerebral circulation contributes to the development of dyscirculatory encephalopathy, and in the future ‒ vascular dementia with a complete loss of performance and self-service capabilities.
Since the etiology and mechanisms of dowager hump are closely related to the progressive pathology of the cervical spine, the development of transient ischemic attacks and such life-threatening complications as ischemic stroke is not excluded. Its occurrence is indicated by unsteadiness of gait, numbness and weakness of the hands, slurred speech. Another potential danger is the formation of an intervertebral hernia, which can compress the nerve root and even the spinal cord.
Diagnostics
In order to build an optimal consistent program to combat dowager hump, it is necessary to carefully assess the state of the spinal column structures. Therefore, the first specialist to visit is a neurologist or a vertebrologist. To identify other risk factors, you may need to consult an endocrinologist, orthopedist. In order to objectify the clinical picture:
- Radiography CV. It allows to identify degenerative changes in the vertebrae and intervertebral discs, pronounced thoracic kyphosis. For more information, X-rays are performed with functional samples.
- Tomography of the spinal column. If it is necessary to clarify the state of the bone tissue, CT diagnostics are resorted to. The condition of the soft tissues surrounding the spine, intervertebral discs and spinal cord is better visualized according to MRI of the spine.
- Assessment of cerebral blood flow. For complaints indicating cerebral circulatory insufficiency, ultrasound of the vessels of the neck is indicated as a screening. If a more in-depth examination is necessary, MR angiography is performed.
- Densitometry. To understand the causes of the dowager hump and take timely measures against its progression, a study of bone mineral density is required. This can be done using ultrasound or X-ray densitometry.
Treatment of dowager hump
Conservative methods
In the initial stage of the formation of a fat roller, methods of physical rehabilitation are effective. Patients are prescribed a set of physical therapy exercises, passive kinesiotherapy, massage of the cervical-collar zone, manual therapy CV. Taping sessions are conducted in order to relieve muscle spasm. With protrusions and hernias, spinal traction can be performed.
Of the methods of physiotherapy, ultrasound and shock wave therapy, therapeutic baths are useful. In the absence of contraindications at home, you can use roller massagers, a Kuznetsov applicator. Patients may be recommended to visit a gynecologist-endocrinologist for the selection of HRT, a nutritionist – in order to develop an individual diet.
Methods of aesthetic medicine
While the dowager hump does not cause unpleasant clinical symptoms, but only violates the aesthetics of the body, you can resort to hardware cosmetic procedures. Effective in relation to this defect are vacuum roller massage, infrared and radio wave thermal lifting, ultrasonic cavitation. These methods make it possible to improve local trophic processes, soften connective tissue strands, and reduce the volume of the dowager hump.
In addition to the hardware correction, lipolytic injections are performed in the problem area. In cases where it is not possible to remove fat deposits noninvasively, surgical liposuction (laser, ultrasonic, vacuum, water jet) is resorted to. During lipoaspiration, from 200 to 1000 ml of fat or more can be removed from the dowager hump at one time.
Prognosis and prevention
If the dowager hump has not yet led to the development of compression syndrome and pronounced degenerative changes in the spinal column, it is possible to cope with the problem in conservative ways. In the future, supportive therapy is required in the form of massage courses, therapeutic swimming, physical therapy. In the advanced stages, the dowager hump ceases to be just a cosmetic flaw, requires the elimination of those complications that threaten the patient or have already arisen.
The prevention of dowager hump mainly comes down to changing behavioral attitudes. The main recommendations for those who are at risk include:
- equipping the workplace with special office furniture (computer chair with back and armrests, ergonomic desk, laptop stand);
- periodic breaks in work with dynamic pauses;
- regular performance of a set of gymnastic exercises for the spine, back and neck muscles;
- changing the diet (abandoning simple carbohydrates and fatty dishes in favor of cereals, vegetables, fish, lean meat);
- choosing the right bedding: orthopedic base and mattress, low pillow.
