Facet joint syndrome, lumbar

• Sprain of facet joint, lumbar
• Arthritic changes in facet joint

• 847.2 Lumbar sprain

• S33 Dislocation and sprain of joints and ligaments of lumbar spine and pelvis
• S33.5 Sprain of ligaments of lumbar spine

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

Description

• 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

Demographics

• Variable, based on specific condition

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

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 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

• Physical Examination
  • Algorithm for examination of the lumbar spine
  • Passive physiological intervertebral mobility testing (PPIVM)
  • Lower extremity screening exam
  • Postural examination
  • Muscle length testing, including hamstrings, hip flexors, calf muscles
  • Quadrant ...