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Condition/Disorder Synonyms

  • Facet joint syndrome, cervical spine

  • Sprain of facet joint

  • Arthritic changes in facet joint

ICD-9-CM Code

  • 847.0 Cervical sprain

ICD-10-CM Code

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

Preferred Practice Pattern

Key Features

Description

  • 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

Essentials of Diagnosis

  • Diagnosis made by clinical examination

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

General Considerations

  • Presentation can vary based on anatomical structures and psychosocial factors

  • C0 to C3 facet joint dysfunction may be associated with cervicogenic headache or dizziness

Demographics

  • Variable based on specific condition

Clinical Findings

Signs and Symptoms

  • 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

Functional Implications

  • May cause decreased ability to perform ADLs/IADLs

  • May impact ability to participate in sports and other recreational activities

Possible Contributing Causes

  • Occupational factors

  • Congenital anomalies

  • Physical condition

  • Smoking

  • Obesity

  • Socio-economic factors

  • Psychosocial and behavioral factors

  • Postural changes including forward-head posture

Differential Diagnosis

  • Peripheral nerve impairment

  • Malignant spinal tumor or metastasis

  • Referred pain from visceral structures

  • Systematic auto-immune diseases (RA, Reiter's, etc.)

  • Radiculopathy

Means of Confirmation or Diagnosis

Imaging

  • 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

Findings and Interpretation

  • Physical Examination

    • Algorithm for examination of the cervical spine

    • Passive physiological intervertebral mobility testing (PPIVM)

    • Upper-extremity screening exam

    • Postural examination

    • Muscle length testing, including upper trapezius, levator scapulae, pectoral muscles

    • Upper limb nerve tension test

    • Deep neck flexor endurance test

    • Upper-extremity neurological ...

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