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Cervical Facet Joint Syndrome

The cervical facet joints are the joints at the posterior (back) aspect of the spine. Each vertebra in your spine has four facet joints, an upper and a lower pair. These joints link the back of the spine together. They are designed to provide stability and control motion between the vertebrae. At each facet joint there is not a lot of movement, however, when all the facet joints are linked together they contribute to a significant amount of movement of the spine and allow complex movements such as flexion, extension and rotation of the spine.

cervical facet joint

The facet joints are the small joints of the spine that are prone to injury, deterioration, and inflammation. Facet joint syndrome can occur anywhere in the spine including the neck. Pain arising from the cervical facet joints is usually at the level of the affected facet joint(s), but can refer pain to other areas of the body including the shoulders, arms and upper back. Generally the pain is made worse by activities that put pressure on these joints i.e. looking upwards and "extending" the neck.

There are a number of potential causes of Facet joint syndrome. The facet joints may be irritated by trauma, repetitive movements, or arthritic changes. It is very common to develop degenerative changes in facet joints after trauma to the spine, as a result of an injury to the intervertebral disc or secondary to degenerative disc disease. When the intervertebral disc is damaged, the cushioning effect of the disc is lost. This then places more stress onto the facet joints as there is less space between their articulating surfaces and may result in degeneration.  Pain sensitive nerve endings can be found in the capsule of the facet joint and are triggered by inflammation.

Poor posture can also cause undue stress on the facet joints. There is a natural curve in the cervical (neck) section of the spine called the cervical lordosis. In this natural position, the facet joints in the neck are designed and positioned to handle a certain amount of stress. When the natural curve of the neck is exaggerated, more stress is placed on the facet joints.

Most cases of facet joint syndrome are diagnosed by a good medical history and physical examination. X-rays of the neck may be used to help rule out degenerative changes in the facet joints or degenerative disc disease if suspected.

The majority of the time cervical facet joint syndrome is treated without surgery. Treatment may involve hands-on physical therapy from a qualified practitioner such as a Chiropractor, Osteopath or Physiotherapist.  Methods of treatment used may include joint mobilisation, manipulation, exercise, and education on good spine posture.  Your GP may also provide anti-inflammatory medications, pain medications and activity modification advice.

In some cases these treatments may not be effective, other options such as facet joint injections may be required. Radiofrequency neurolysis can be used, this is a procedure which blocks the pain messages transmitted by nerves that supply the affected facet joint. Surgery is rarely required.

Most individuals with facet joint syndrome will recover and return to normal activities. Ensuring correct posture both at work and play alongside a gentle neck stretching and strengthening regime will help to prevent future episodes of pain.

Recent research has indicated that a combination of spinal manipulation and exercise added to GP best care advice is the most cost effective form of treatment for non-specific neck pain (Bronfort et al, 2012). This is also confirmed by the NHS Evidence Service recommended plan of action for the treatment of non-specific neck pain. Thoracic spine manipulation is also recommended for reducing pain and disability in patients with neck and neck-related arm pain (Gonzalez-Iglesias J. et al, 2009).

By Shelley Doole DC MChiro

References

Bronfort G, Haas M, Evans R, Leininger B, Triano J: Effectiveness of manual therapies: the UK evidence report. Chiropr Osteopat 2010, 18:3.

Bronfort G, Evans R, Anderson AV, Svendsen KH, Bracha Y, Grimm RH. (2012). Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomized trial.  Annals of Internal Medicine. 156 (1), 1-10.

Gonzalez-Iglesias J, Fernandez-de-las-Penas C, Cleland JA, Gutierrez-Vega MR: Thoracic spine manipulation for the management of patients with neck pain: a randomized clinical trial. J Orthop Sports Phys Ther 2009, 39:20-27.

Gross AR, Hoving JL, Haines TA, Goldsmith CH, Kay T, Aker P, et al.: Manipulation and mobilisation for mechanical neck disorders.  Cochrane Database Syst Rev 2004, CD004249.