Facet joint syndrome, cervical

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

• 847.0 Cervical sprain

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

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

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

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

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

• 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 screen (dermatome, myotome, reflexes)

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

• Hypomobile cervical spine
• Weakness of deep neck ...