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  • Facet joint syndrome, cervical spine
  • Sprain of facet joint
  • Arthritic changes in facet joint

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  • 847.0 Cervical sprain

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  • S13.8XXA Sprain of joints and ligaments of other parts of neck

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Description

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  • Neck pain with primary involvement of cervical facet joint
  • Upper limb symptoms might be present in a non-dermatomal pattern as a result of referred pain
  • No neurological findings
  • Unilateral symptoms

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Essentials of Diagnosis

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  • Diagnosis made by clinical examination
  • Reproduction of symptoms when joint in closed-packed position (combination of extension, side-bending, and rotation toward involved side)

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General Considerations

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  • Presentation can vary based on anatomical structures and psychosocial factors
  • C0 to C3 facet joint dysfunction may be associated with cervicogenic headache or dizziness

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Demographics

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  • Variable based on specific condition

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Signs and Symptoms

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  • Pain in cervical area that can be reproduced mechanically
  • Unilateral or bilateral referred pain in upper extremities possible in a non-radicular pattern
  • Active range of motion (AROM) limited in a capsular pattern; rotation and side-bending limited in same direction
  • Cervical segmental hypomobility may be present in capsular pattern
  • Can be associated with forward-head posture

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Functional Implications

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  • May cause decreased ability to perform ADLs/IADLs
  • May impact ability to participate in sports and other recreational activities

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Possible Contributing Causes

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  • Occupational factors
  • Congenital anomalies
  • Physical condition
  • Smoking
  • Obesity
  • Socio-economic factors
  • Psychosocial and behavioral factors
  • Postural changes including forward-head posture

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Differential Diagnosis

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  • Peripheral nerve impairment
  • Malignant spinal tumor or metastasis
  • Referred pain from visceral structures
  • Systematic auto-immune diseases (RA, Reiter's, etc.)
  • Radiculopathy

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Imaging

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  • Not necessary in most cases; only with persistent symptoms that do not respond to conservative management or presence of red/yellow flags
  • MRI helps visualize compressed or inflamed nerve root/disc pathology in diagnosis
  • X-ray/plain-film radiograph helps assess alignment, fractures, stability (flexion/extension radiograph)
  • CT scan to show herniation compressing the spinal canal or nerves
  • Electrodiagnostic/nerve conduction testing can help determine a specific impaired nerve function
  • Doppler ultrasound to examine vascular function

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  • For imaging
  • For surgical consult if myelopathy suspected (lumbar radiculopathy)
  • For imaging and medical consult if disease suspected
  • If vascular insufficiency suspected

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  • Hypomobile cervical spine
  • Weakness of deep neck flexors and upper-extremity stabilizers
  • Shortening of upper trapezius, levator ...

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