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Condition/Disorder Synonyms

  • Sprain of facet joint, lumbar

  • Arthritic changes in facet joint

ICD-9-CM Code

  • 847.2 Lumbar sprain

ICD-10-CM Code

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

  • S33.5 Sprain of ligaments of lumbar spine

Preferred Practice Pattern

Key Features


  • Low back pain (LBP) with primary involvement of lumbar facet joint

  • Lower limb symptoms might be present in a non-dermatomal pattern as a result of referred pain

  • Neurological 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 closed packed position (combination of extension, side-bending towards involved side, rotation away from involved site)

General Considerations

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

  • Often difficult to diagnose cause of pain


  • Variable, based on specific condition

Clinical Findings

Signs and Symptoms

  • Pain in 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 in opposite direction

  • Lumbar segmental hypomobility may be present in capsular pattern

  • May be associated with poor core-muscle strength and postural deviations

Functional Implications

  • Leading cause of occupational disability

  • 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

  • Weakness of core musculature

  • Tightness of hip flexors, external rotators, hamstrings

Differential Diagnosis

  • Vascular insufficiency

  • Peripheral nerve impairment

  • Hip pathology with radiating pain-pattern

  • Malignant spinal tumor or metastasis

  • Referred pain from visceral structures

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

  • Ankylosing spondylitis

  • Abdominal aortic aneurism

  • Radiculopathy

Means of Confirmation or Diagnosis


  • Not necessary in most cases; only with persistent symptoms that do not respond to conservative management or presence of red/yellow flags

  • MRI helps to visualize compressed or inflamed nerve root/disc pathology in diagnosis

  • X-ray/plain-film radiograph helps to assess alignment, fractures, stability (flexion/extension radiograph)

  • CT scan to show herniation compressing the spinal canal/nerves, rule out abdominal pathology

  • Electrodiagnostic/nerve conduction testing can help to determine a specific impaired nerve function

  • Doppler ultrasound to examine vascular function ...

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