Cervical Facet Syndrome

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 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.

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 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 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

Injections 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