By Stephen Ducker, M.D.
Cervical facet syndrome consists of multiple pain symptoms involving the neck, head, shoulders, and proximal upper extremities. The dull and ill-defined pain radiates from the facet joints in the cervical spine to areas of the head, neck, and upper back in an overlapping and nonspecific fashion as discussed below. The pain may be on one or both sides of the neck and is thought to emanate from the facet joints as the name implies. Simply put, the facet joints are pairs of small joints that arise from adjacent vertebrae and consist of two bony articular processes, a cartilage where the surfaces of the articular processes interface, a joint capsule surrounding the joint made of strong fibrous connective tissue and a synovial membrane which lines the inside of the joint capsule. The primary functions of the cervical facet joints are to keep the spine aligned and to prevent excessive movement of the vertebra relative to each other. The facet joints receive nerves from two different levels of the spine, one nerve at the same level and one nerve from the level above the joint. This fact helps to explain why the pain from cervical facet joints is so nonspecific and poorly defined.
Some of the hallmarks of cervical facet syndrome are tenderness to deep palpation (manual pressure) of the muscles surrounding the cervical spine during physical examination, often associated with muscle spasms. In addition, the patient will often experience a limited range of motion upon flexion, extension, rotation and lateral bending of the neck.
As you will recall from previous discussions, there are 7 cervical vertebrae numbered C1-C7. As stated above, the facet joints are comprised of bony extensions from a superior and an inferior vertebra, such as C1-C2, C2-C3, C3-C4, C4- C5, C5-C6 and C6-C7. Pain from the C1-C2 facet may be referred to the area behind the ear as well as the lower portion of the skull as it interfaces with the neck. The latter area is referred to as the occipital region. C2-C3 facet joint pain may be felt in the upper portion of the neck as well as the forehead and eyes. Pain from the C3-C4 facet joints will be referred to below the occipital region and into the lower side portions of the neck. If the C4-C5 facet joints are involved, the pain will be experienced in the base of the neck. C5-C6 facet joint pain will be referred to the shoulders and between the shoulder blades and pain from the C6 -C7 facets will be referred to the areas overlying the shoulder blades.
Facet joint pain can have a variety of etiologies or causes. As with any other joints in the body, degeneration takes place with the normal wear-and-tear of aging. Therefore, osteoarthritis and/or degenerative disease may lead to the wearing out of the cartilage within the facet joint causing a bone-on-bone articulation. This in turn may lead to osteophytes (bone spurs) and or facet joint hypertrophy, which is an enlargement/swelling of the joint. Both the bone spurs and enlargement of the joint occupies space which may impinge or press upon nervous tissue including the spinal cord or the nerve roots, both of which situations may cause pain.
Facet joint pain secondary to an automobile accident associated with whiplash is also common. This pain may be experienced as muscle pain and tenderness alongside of the neck.
Whiplash is caused by a rapid hyperextension and hyperflexion of the neck, as is often experienced in a rear end motor vehicle collision.
The diagnosis of cervical facet syndrome is carried out with a combination of clinical history, physical examination, x-rays, and MRIs, as well as diagnostic intra-articular injections of the joint with a local anesthetic. If local anesthetic is injected in the joint and pain relief is experienced by the patient, then it can be concluded that the neck pain is caused by that specific facet joint.
Cervical facet syndrome can be treated with multiple modalities. Physical therapy using heat/cold, deep massage, nonsteroidal anti-inflammatory agent and muscle relaxants are usually the initial treatments of choice. If satisfactory pain relief is not achieved, a cervical facet injection utilizing a local anesthetic combined with a steroid is usually the next step. If pain control is still not achieved, the nerve supplying the facet joints can be disrupted with what is called a radiofrequency ablation.
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