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121: FACET JOINT SYNDROME, LUMBAR

Arie J. Van Duijn, EdD, MSc, PT, OCS; Eric Shamus, PhD, DPT, PT, CSCS

CONDITION/DISORDER SYNONYMS

  • Sprain of the facet joint, Lumbar

  • Arthritic changes in the facet joint

ICD-9-CM CODE

  • 847.2 Lumbar sprain

ICD-10-CM CODES

  • S33 Dislocation and sprain of joints and ligaments of lumbar spine and pelvis

  • S33.5 Sprain of ligaments of lumbar spine

PREFERRED PRACTICE PATTERN

  • Pattern 4F: Impaired Joint Mobility, Motor Function, Muscle Performance, Range of Motion, and Reflex Integrity Associated with Spinal Disorders1

PATIENT PRESENTATION

A 35-year-old man presents with a sudden onset of low back pain (LBP) 5 days ago, following bending over to pick up an item from the floor. The pain is located along the right side of the lumbar spine, sometimes radiating to the buttock region. Muscle guarding is present along the right side of the lumbar spine. Pain and loss of active range of motion is noted with forward bending, left side bending, and right rotation. Passive intervertebral motion (PIVM) testing revealed significant loss of passive mobility in the same directions. Neurologic examination was unremarkable.

KEY FEATURES

Description

  • LBP with primary involvement of the lumbar facet joint

  • Lower limb symptoms might be present in a nondermatomal pattern as a result of referred pain

  • Neurologic findings, minimal

  • Unilateral symptoms

Essentials of Diagnosis

  • Diagnosis made by clinical examination

  • Use of treatment- (impairment) based classification system is useful to determine evidence-based practice (EBP) treatment plan

  • Reproduction of symptoms when putting joint in a closed packed position (combination of extension, side-bending toward involved side, rotation away from involved site)

FIGURE 121-1

The fifth lumbar vertebra viewed from above (A) and from the side (B). (From Ropper AH, Samuels AH. Adams & Victor’s Principles of Neurology. 9th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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FIGURE 121-2

Lumbar medial branch nerve and facet blocks. (A) Posterior view. (B) 30-degree oblique posterior view. (From Morgan GE, Mikhail MS, Murray MJ. Clinical Anesthesiology. 4th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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General Considerations

  • Presentation can vary significantly based on anatomical structures and psychosocial factors.

  • Often difficult to diagnose the cause of pain.

Demographics

  • Variable, based on specific condition.

CLINICAL FINDINGS

SIGNS AND SYMPTOMS

  • Pain in the lumbar or sacral area that can be mechanically reproduced

  • Possible unilateral or bilateral referred pain, or pain in lower extremities

  • ROM limited in a capsular pattern: rotation and side-bending limited ...

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