Cervical facet joint dysfunction [without radicular involvement] is a common but relatively benign problem that results in loss of mobility and stiffness of the neck.
Causes
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. Causes of cervical facet syndrome include:
- Degeneration or general wear and tear of the joint, can cause cervical facet syndrome.
- Disc degeneration may cause loss of height between vertebra, placing a greater compression force on the posterior facet joints.
- Extension (backward) motions can produce compression on the facet joints which can lead to degenerative.
- Sudden fall or 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 cervical facet syndrome.
- Muscle weakness and poor posture.
- Joint stiffness.
- Sedentary lifestyle.
Symptoms
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 in the neck, shoulder blade 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 spasm and changes in posture in response to the injury.
- Loss of motion of 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.
- Increased size or visible deformity of the joint.
- A sensation of “cracking” or “crunching” with movement of the spine.
Treatment
Treatment of cervical facet syndrome will depend on the severity of the condition. Treatment recommendations for cervical facet syndrome include:
- Rest: avoid the activities that produce the pain (overhead activities, looking up, lifting, twisting, of the head and neck)
- Medication to reduce inflammation (anti-inflammatory drugs and pain medication)
- Ice: apply ice to the cervical spine to help reduce pain and associated muscle spasm. 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.
- Bracing or the use of 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.
Mild
In mild cases rest, ice and medication may be enough to reduce the pain. Many patients will do well with this regiment. Physical therapy is recommended to develop a series of stretching and strengthening exercises to prevent reoccurrence of the injury. Return to activity should be gradual to prevent a flare up of symptoms.
Moderate to Severe
If the problem persists, consulting with your health care provider should be the next step. Your physician will 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.
Medical interventions
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
Physical therapy
Physical therapy methods and techniques to produce changes consistent with the diagnosis, prognosis and the patient or client’s goals.
Your physical therapist will perform a thorough evaluation to assess and determine the following:
- Spinal examination where the patient is put through a series of movements and tests to determine the most probable cause of your current back condition.
- Strength: resisted testing is performed to determine if there is associated weakness or strength imbalances.
- Flexibility: tight muscles can contribute to poor mechanics and weakness creating imbalances and making one more susceptible to disc and back injuries.
- Posture Analysis, ADL’s and technique: discuss and observe the activity that may have started the problem. Examination of dynamic and static postures that may have cause or contributed to your current back problem. A review of your current activities at home and work that may or may not be causing or prolonging your present condition.
Physical therapy interventions
Common Physical Therapy interventions in the treatment of cervical facet syndrome include:
- Manual Therapeutic Technique (MTT): hands on care including soft tissue massage, stretching and joint mobilization by a physical therapist to improve alignment, mobility and range of motion of the neck and cervical spine. Use of mobilization techniques also help to modulate pain.
- Therapeutic Exercises (TE) including stretching and strengthening exercises to regain range of motion and strengthen muscles of the back and abdominals to support, stabilize and decrease the stresses place on the spinal joints, discs, and neck.
- Neuromuscular Reeducation (NMR) to improve posture, restore stability, retrain the patient in proper sleeping, sitting and body mechanics to protect the injured spine.
- Modalities including the use of ultrasound, electrical stimulation, ice, cold laser, traction and others to decrease pain and inflammation spinal structures.
- Home programs including strengthening, stretching and stabilization exercises and instructions to help the person perform daily tasks and advance to the next functional level
Prognosis
Most facet problems improve without surgery and return to normal function. Duration of treatment can range from 4 to 12 weeks depending on the severity of the symptoms. Patients need to continue with a regiment of stretching, strengthening and stabilization exercises. Use of proper mechanics, proper posture, body mechanics and awareness of the do’s and don’ts for a healthy back is necessary for a good prognosis long term. Remember, “once you have a neck problem, you have a neck problem” goes a long way to preventing further injury.