A widow’s hump, also known as a dowager’s hump or kyphosis, is an abnormal curvature of the upper spine that causes a hump at the back of the neck. It typically develops in older women, hence the name “widow’s hump”, but can occur in anyone at any age.
What Causes a Widow’s Hump?
A widow’s hump is caused by excessive curvature of the thoracic spine, which is the upper back area between the base of the neck and the bottom of the rib cage. This exaggerated curvature is known as hyperkyphosis.
There are a few potential causes of hyperkyphosis that can lead to a widow’s hump:
- Osteoporosis – This condition causes bones to become weak and brittle. The vertebrae of the spine are especially susceptible, which allows the spine to curve abnormally.
- Degenerative disc disease – Discs between the vertebrae deteriorate, losing height and flexibility. This causes the spine to collapse and curve forward.
- Vertebral fractures – Fractures of the small vertebrae in the upper back due to injury or osteoporosis can cause the spine to curve and form a hump.
- Muscle weakness – Weak postural muscles allow poor posture and increased curvature of the upper spine over time.
- Scheuermann’s kyphosis – An abnormal growth pattern in the spine during adolescence leads to wedging of the vertebrae and kyphosis.
Older women are more prone to widow’s humps because they are at higher risk for osteoporosis and degenerative disc disease. However, younger people can develop hyperkyphosis due to Scheuermann’s kyphosis or other causes.
Signs and Symptoms
The main sign of a widow’s hump is a protruding bump at the upper back. Other signs and symptoms may include:
- Stooped posture
- Rounded shoulders
- Head and neck tilted forward
- Back pain or stiffness
- Reduced height
- Shortness of breath or heartburn
- Spinal cord or nerve compression (in severe cases)
The hump may start out small but gradually increase in size over time as the spine curvature worsens. Clothing may not fit properly around the upper back and shoulders due to the hump.
Appearance
A widow’s hump can vary in shape and size depending on the severity of the upper back curvature. Here are some characteristics of how a dowager’s hump may appear:
- Size – Can range from a small hump of 1-2 inches to a large, prominent hump of 5 inches or more. Severe cases can have humps exceeding 10 inches.
- Shape – Rounded, convex shape protruding from the upper spine. The hump has a characteristic “hunched” look.
- Location – Develops right at the base of the neck, overlying the upper thoracic spine.
- Symmetry – Often asymmetrical, with the hump more pronounced on one side.
- Skin over hump – Stretched and thin skin covering the protrusion. May have visible veins.
Mild Widow’s Hump
In mild cases, the dowager’s hump appears as a small, rounded hump measuring 1-2 inches across. It protrudes subtly from the upper back when viewed from the side. The skin is mildly stretched over the protrusion but there are no highly visible veins. From the front or back, the upper back and neck alignment may appear relatively normal.
Moderate Widow’s Hump
A moderately severe widow’s hump is more prominent, measuring around 2-4 inches across. The hump is rounded and clearly visible protruding from the upper back. Some asymmetry may be apparent. Skin over the hump appears stretched and thin. Posture is stooped, with head forward and shoulders rounded.
Severe Widow’s Hump
In advanced cases, the hump is very pronounced and obvious. It protrudes significantly from the back, measuring over 4 inches across. The hump is very rounded and convex, and highly asymmetrical. Thin, stretched skin overlies the protrusion with visible veins. Posture is extremely stooped and deformed by the severe curvature. The head juts forward and neck posture is abnormal.
Diagnosis
A widow’s hump is diagnosed by a physician through a physical exam and imaging tests. The exam assesses posture and spine curvature. Imaging such as x-rays or MRI evaluates the degree of upper spine curvature and checks for complications.
The angle of the kyphosis is measured to determine severity. A curve over 50 degrees is considered severe hyperkyphosis. The doctor also checks for signs of underlying disorders such as osteoporosis or vertebral fractures.
Treatment
Treatments for a widow’s hump aim to alleviate symptoms, stop progression, and improve appearance. Options may include:
- Osteoporosis medications – Bisphosphonates or other anti-resorptive drugs to strengthen bones and prevent worsening.
- Back bracing – Custom braces worn daily to improve posture and support the spine.
- Spinal fusion – In severe cases, surgery to fuse together vertebrae may be done.
- Posture training – Stretching and exercises to improve posture and back strength.
- Pain medications – Over-the-counter or prescription medicines to relieve back pain.
- Injections – Steroid injections can reduce inflammation and pain.
Treatment is most effective when started early. Severe dowager’s humps that have been present for many years are difficult to correct completely. Physical therapy and postural training may help stabilize progression but cannot reverse established deformity. Surgery carries substantial risks and may not be an option for older patients.
Prevention
To help prevent developing a widow’s hump:
- Build bone strength with calcium, vitamin D, and possibly medications for osteoporosis.
- Use good posture when sitting, standing, and sleeping.
- Perform exercises to strengthen the back, core, and shoulders.
- Avoid activities that place excessive loads on the spine.
- Manage chronic conditions such as arthritis that can lead to poor posture.
- Get treatment for injuries or pain that cause slumped posture.
Older individuals, especially women, should be particularly cautious and have regular medical checkups to screen for osteoporosis. Early diagnosis and treatment of bone loss can help prevent dowager’s humps.
Outlook
Small widow’s humps may cause only mild cosmetic concerns and can often be improved with physical therapy. More pronounced humps can have greater postural impact and lead to pain, breathing issues, and spinal problems if left untreated.
Severity of the dowager’s hump depends on the underlying cause and how early treatment is initiated. Mild cases detected early are more likely to respond well to posture training and physical therapy.
Severe widow’s humps present greater challenges for improvement, but bracing and medications may at least prevent further progression. Surgery can correct deformity but involves substantial risks that must be carefully weighed.
With appropriate treatment, most people with a dowager’s hump can stabilize the condition and experience reduced symptoms. However, without ongoing management, the hump may gradually worsen over time.
When to See a Doctor
Consult a physician if you notice a protruding hump at the base of your neck. Seek prompt medical attention for:
- Significant change in posture or development of a hump
- Increasing upper back pain, stiffness, or loss of flexibility
- Breathing problems, heartburn, or swallowing difficulties
- Neurological symptoms like numbness or tingling in the arms or legs
- Unexplained height loss of 1 inch or more
Early evaluation and treatment can help manage widow’s hump progression and avoid complications. People with known osteoporosis should be vigilant for postural changes and consult their doctor at the first sign of any abnormalities.
Conclusion
A widow’s hump is an excessive curvature of the thoracic spine leading to a protruding hump at the upper back. The condition typically develops due to osteoporosis, degenerative disc disease, or vertebral fractures. Symptoms include postural changes, back pain, breathing issues, and spinal complications in severe cases.
Treatment aims to alleviate symptoms and halt progression. While small humps can often be improved with posture training and physical therapy, large deformities are difficult to correct completely. However, early diagnosis and appropriate management can stabilize the condition for most patients.