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It has been estimated that the prevalence of neck pain in the general population is approximately 34%. The term cervical facet syndrome is used to describe a number of symptoms associated with degenerative changes of the joints (facets) on either side of the disc
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Many pain sensitive structures are located in the cervical spine, including the intervertebral discs, facet joints, ligaments, muscles, and nerve roots. The facet joints have been found to be a possible source of neck pain, and the diagnosis of cervical facet syndrome is often made only by a process of elimination of all other pathologies.
Clinical features that are often associated with cervical facet syndrome include tenderness to palpation over the facet joints or paraspinal muscles, pain with cervical extension or rotation, and absent neurological abnormalities.
Imaging studies (X-Rays, CT’s and MRI’s) usually are not helpful, with the exception of ruling out other sources of pain, such as fractures or tumors. It is very important to realize that signs of cervical spondylosis (arthritis), narrowing of the intervertebral foramina (stenosis), osteophytes (bony growths), and other degenerative changes are equally prevalent in people with and without neck pain.
Cervical facet joint pain is also a common sequela of whiplash injury. The prevalence of cervical facet joint pain after whiplash injury has been shown to be as high as 60%.
The facet joints in the cervical spine are synovial joints with fibrous capsules (structurally essentially like other major joints such as knee/shoulder/ankle etc..). The fibrous capsules are innervated by mechanoreceptors (structures that detect a change in physical stress). Interestingly there are more mechanoreceptors in the cervical spine than in the lumbar spine (this increased neural input from the facets may be important for proprioception – or movement awareness/feedback/movement control - and pain sensation and may modulate protective muscular reflexes that are important in preventing joint instability and degeneration).
People with cervical facet joint syndrome often present with neck pain, headaches, and limited range of motion (ROM) especially into extension (looking up) and rotation. The pain is described as a dull, aching discomfort in the posterior neck that sometimes radiates to the shoulder or mid back regions. It can also be quite sharp at the end of available range.
Each facet joint seems to have a particular radiation pattern upon painful stimulation. But the pain has been reported to travel from the base of the skull as far down as to the shoulder blade region. (see diagram below)
Treatment
Acute Phase
The goals of the first phase of treatment are to reduce pain and inflammation, and increase the pain-free movement. Ice is indicated during the acute phase to decrease blood flow and subsequent hemorrhage into the injured tissues, as well as reducing local oedema. Application of ice can also reduce acute muscle spasm.
Painkillers such as regular panadol or codeine based medication can help for pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be helpful in reducing inflammation a few days after the onset of pain.
Physiotherapy modalities such as manual therapy (joint mobilization, soft-tissue massage, and muscle stretching) are often helpful. Passive range of motion (PROM) and then active range of motion (AROM) exercises in a pain-free range should be initiated in this phase. Finally, strengthening should begin with isometric exercises and progress to isotonic as tolerated.
Surgical Intervention
Cervical fusion should be considered with great caution and only after aggressive nonsurgical care has failed.
Other Treatment
- Intra-articular facet joint injections
- Medial branch blocks
- Percutaneous radiofrequency neurotomy
NOTE: A review of recent literature reveals that there is a lack of clinical evidence supporting the effectiveness of injection therapy, medial branch blocks carry a risk of unpleasant side effects and PRN although effective at reducing pain, often has to be repeated every 6-9 months.
Recovery Phase
Patients with cervical facet syndrome should transition into the recovery phase of rehabilitation when they are nearly pain free. The goals of this phase are to completely eliminate pain and further increase ROM, strength, and neuromuscular control. Manual therapy with soft-tissue massage and mobilization along the plane of the facet joint to restore natural joint glide may still be required, but emphasis is placed on improving strength, flexibility, and neuromuscular control.
Maintenance Phase
The goals of the maintenance phase are to balance strength and flexibility and to increase endurance of the stabilizing muscles around the neck. This should be achieved by compliance to a progressive exercise program, which can be performed independently.
Return to sport is an individualized process for people with cervical facet syndrome. Safe return to play is allowed after the appropriate sport-specific rehabilitation program is completed and the person demonstrates full pain-free ROM and proper neutral spine posture with sport-specific activities.