Neck blog series: part 3: Cervical facet syndrome

What is Cervical Facet Joint syndrome?

Ghormley (1933) first coined the term facet syndrome to describe symptoms associated with degenerative changes of the lumbar spine. Relatively recently, the term cervical facet syndrome has appeared implying spinal pain presumably secondary to involvement of the posterior articular pilars of the cervical spine.

A severe acute episode of Facet joint pain may be due to sudden trauma or more often, Facet pain/Facet Syndrome is chronic in nature – with underlying long term changes in the Facet joint that are often associated with degenerative disc disease.

It is not synonymous with Cervical Spondylosis.

It can occur with other structural sources of pain simultaneously.

How much of a problem is Facet joint syndrome?

Facet joints have been implicated as a cause of chronic spinal pain in 54-67% of patients with chronic neck pain. These figures were based on responses to controlled diagnostic facet joint blocks performed in accordance with the criteria established by the International Association for the Study of Pain (IASP).

What are the common symptoms of Facet joint syndrome?

Referred peripherally into the ipsilateral (same side) shoulder and/or pericapsular region (Dwyer et al).

Dull aching discomfort in the posterior neck that sometimes radiates to the shoulder or mid back regions.

Each facet joint seems to have a particular radiation pattern upon painful stimulation. Even in subjects without neck pain, stimulation of the facet joints by injecting contrast material into the joints and distending the capsule produces neck pain in a specific pattern corresponding to the specific joint:

Pain on movement related to articular patterns causing limited motion, capsular distension in extension and rotation will stimulate a pain response. A reduction of capsular distension will therefore reduce pain.

Tenderness to palpation over the facet joints or paraspinal muscles will be provocative and there should be no neurologic abnormalities.

The facet/Zygapophysial joint itself is subjected to tissue mechanisms including degenerative, inflammatory, traumatic, or mechanical problems.

What causes Facet joint syndrome?

Distension of the Facet/Zygapophysial joints refer pain beyond the immediate area.

Patients also may report a history of a previous whiplash injury to the neck.

Patients may have a history of sporting trauma, poor working and sporting ergonomics.

Posture related!

How do you diagnose Facet joint syndrome?

Palpation to the facet joints in the neck is accurate to help diagnose neck injury to a probability of 82% (Cleland & Koppenhaver 2005).

Bogduk and Marsland,1988. Used medial branch blocks and zygapophysial blocks were causes of neck pain.

Bogduk and Aprill ’93 suggested that cervical medial branch blocks along with discography to identify all sources of pain.

Radiographic findings are not conclusive!

Imaging studies are usually not helpful, with the exception of ruling out other sources of pain, such as fractures or tumours. CT scanning is more reliable to confirm structural changes to facet joints.

So what can help?

Acute phase

Goals of the first phase are to reduce pain and inflammation, and increase the pain-free range of movement. Ice is indicated during the acute phase to decrease blood flow and subsequent haemorrhage into the injured tissues, as well as reducing local oedema. Application of heat can be used to reduce muscle spasm. Therapeutic modalities such as ultrasound and electrical stimulation may also reduce painful muscle spasms as well. Manual therapy, joint mobilisation, soft tissue massage, and muscle stretching are often helpful. Passive range of motion and then active range of motion exercises in a pain-free range should be initiated in this phase. Finally, strengthening should begin with isometric exercises and progress to isotonic as tolerated.

Recovery phase

Patients should transition into the recovery phase of rehabilitation when they are nearly pain free. The goals of this phase are to eliminate pain and further increase range of movement, strength, and neuromuscular control. Manual therapy with soft tissue massage and mobilisation still may be required, but emphasis is placed on improving strength, flexibility, and neuromuscular control.

Maintenance phase

Patients are ready for the final phase of rehabilitation after they have achieved full and pain-free range of movement, and a significant improvement in strength. The goals of the maintenance phase are to balance strength and flexibility, and to increase endurance.

Surgical, facet joint denervation has been successful but continues to be an area of controversy. Recent ideas of simultaneous multiple origins of cervical pain has directed research.

Pulsed radiofrequency neurotomy has been shown to have some success but again remains the subject of debate.

What is my prognosis?

Acute episodes usually resolve well over approximately 12 weeks but if the problem is long standing and caused by poor posture or working issues then prognosis is poor as the only true way to fully resolve the problem is to rectify the working or posture related problems.

If you need any further information or would like to book an appointment then call Hawkes Physiotherapy on 01782 771861 or 07866195914

Stay tuned for the next neck series blog article, part 4, coming soon!

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