Anatomy & Background
What are Facet Joints?
Aside from the upper cervical spine (C1,C2 ) all other cervical vertebral levels consist of three joints. There is one joint consisting of the intervertebral discs which connect the bodies of the vertebra. There are also two posterior and lateral joints with one on each side called facet joints. The facet joints provide support, stability and facilitate motion of the cervical spine.
Facet joints are synovial joints, which have a smooth shiny contact surfaces called the articular cartilage. The articular cartilage allows the bones to slide freely over each other with reduced friction and stress. Each joint is also surrounded by a protective sleeve called a capsule, and is lubricated by synovial fluid. The facet joints can become irritated and inflamed producing pain and dysfunction.
Common conditions of the facet joints include spondylosis, osteoarthritis of the spine, facet joint inflammation, degenerative joint disease of the spine and facet arthropathy.
Facet joint irritation is a common cause of neck and arm pain. Facet joints, like other synovial joints, are susceptible to wear-and-tear, degeneration, inflammation and arthritic changes. Inflammation and degenerative changes to the facet joints may result in pain, loss of motion, and if severe encroachment or pinching of the nerve exiting the spinal column. Common causes of facet joint irritation include:
- Degeneration, arthritic changes or general wear-and-tear of the joint over time.
- Disc degeneration may cause loss of height between vertebra, placing a greater compression force on the posterior facet joints.
- Backward motions can produce compression on the facet joints which can lead to degenerative and eventual arthritic changes.
- A sudden fall or a trauma, like a motor vehicle accident, can result in a facet joint irritation.
- Genetic factors can contribute to the likelihood of degenerative joint disease.
- Repetitive stress injuries like those from lifting or carrying heavy loads, or performing over the head motions that keep the neck and head in an extended position can cause facet joint irritation.
- Muscle weakness and poor posture.
- Joint stiffness.
Symptoms of Cervical Facet Syndrome
When a facet joint is irritated, the symptoms will depend on the location of the facet joint and what soft tissue structures are affected. Symptoms can vary from mild to severe and may mimic the symptoms of a disc problem. Other common symptoms include:
- Pain felt in the neck, shoulder blades or radicular to the shoulder into the arm. Pain is rarely felt in the hand or fingers.
- Pain and tenderness localized at the level of the involved facet joint.
- Muscle spasms and changes in posture in response to the injury.
- Loss of motion to the neck including an inability to turn the head, look up or bend backward, or move sideways to the effected side.
- Sitting for extended periods of time or performing activities overhead will be difficult.
Treatment of Facet Joint Injury
Treatment of a facet joint irritation or injury will depend on the severity of the condition. Treatment recommendations for cervical facet joint injury include:
- Rest. Avoid the activities that produce the pain (overhead activities, looking up, lifting, twisting of the head and neck, etc).
- Anti-inflammatory drugs and other pain medications.
- Apply ice to the cervical spine to help reduce pain and associated muscle spasms. Apply ice right away and then at intervals for about 20 minutes at a time. Do not apply directly to the skin.
- An exercise regiment designed specifically to address the cause of the symptoms and facet joint irritation.
- The use of braces or other supports may be necessary to reduce stress on the facet joints, muscles and cervical spine or neck.
- Steroidal medication to reduced inflammation in moderate to severe conditions.
- Facet joint injections directly to the involved joint.
- Physical therapy to reduce inflammation, restore joint function, improve motion, and help return to full function.
In mild cases patients found that rest, ice and medication were enough to reduce the pain. Physical therapy is recommended to develop a series of stretching and strengthening exercises to prevent re-occurrence of the injury. Return to activity should be gradual to prevent a flare up of symptoms.
Moderate to Severe Cases
If the problem persists, consult with your health care provider. Your physician should perform a thorough evaluation to determine the possible cause of your symptoms, the structures involved, the severity of the condition, and the best course of treatment.
In addition to performing a thorough examination your physician may order the following tests to make a more concise diagnosis:
- X-ray to determine if there is any joint degeneration, fractures, bony malformations, arthritis, tumors or infection present.
- MRI to determine any soft tissue involvement including visualization of the discs, spinal cord and nerve roots.
- CT scans, which can give a cross section view of the spinal structures
Medications to consider
Your physician may recommend several medication options individually or in combination to reduce the pain, inflammation and muscle spasms that may be associated with facet joint injuries.
- Over the counter medications for mild to moderate pain.
- If over the counter medications are not effective your physician may prescribe stronger pain medication.
- Anti-inflammatory drugs or prescription NSAIDS (non-steroidal anti-inflammatory drugs) to reduce inflammation following acute injury.
- Muscle relaxers to reduce acute muscle spasm.
- Injections such as facet injections, nerve blocks or epidural injections. These may involve the injection of corticosteroids to a specific structure to reduce local inflammation.
Severe or Non-Responsive Conditions
In the case of conditions that do not respond to conservative care surgery may be indicated. If you continue to experience some of the following symptoms surgery may be necessary:
- An increase in radiating or radicular pain
- Pain or nerve irritation that gets worse over time
- Associated disc involvement
njections like facet injections, nerve blocks or an epidural. These may involve the injection of corticosteroids to a specific structure to reduce local inflammation.
- Caudal Epidural Injections
- Facet Joint Injections
- Interlaminar Caudal Epidural Steroid Injections
- Medial Branch Blocks
- Selective Nerve Root Blocks
Surgical Procedures to reduce the affects of degeneration on pain producing structures of the spine.
- Endoscopic Decompression
- Endoscopic Foraminotomy
- Laser Facet Rhizotomy
- Facet Thermal Ablation
- Radiofrequency Ablation