Facet Joint Pain
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Introduction
Root cause of facet joint pain are arthrotic degenerations and sometimes instability of zygapophysial joints. Facet pain is a common cause of chronic neck and especially chronic low back pain. It is more common in the elderly population and is difficult to diagnose as facet degenerations in imaging does not correlate well with pain.
Examination of Zygapophysial (Facet) Joint Arthropathy
- History & Symptoms: Patients typically present with chronic neck, mid-back, or lower back pain. The pain is often worse with spinal extension, rotation, or transitioning from sitting to standing, and may be associated with morning stiffness.
- Physical Examination: No specific clinical signs definitively diagnose facet joint pain. Physical exam may reveal limited range of motion (especially in extension and rotation), muscle tenderness near the affected joints, and local pain on palpation. Some practitioners perform segmental spinal assessments, including testing motion through flexion, extension, side bending, and rotation, and palpation for asymmetry and muscle texture changes.
- Diagnostic Injections: Because physical findings are nonspecific, the most reliable diagnostic method is the use of local anesthetic injections (medial branch blocks ‘MBB’ or intra-articular facet joint injections). Significant pain relief after these injections strongly suggests the facet joint as the pain source, though false positives/negatives may occur.
Treatment of Zygapophysial (Facet) Joint Arthropathy
Conservative Treatment
- Nonsteroidal anti-inflammatory drugs (NSAID), muscle relaxants, topical agents
- Physical therapy and targeted exercise to improve flexibility, strength, and posture.
- Activity modification, ergonomic advice, and lifestyle changes.
- Some manual or osteopathic techniques (mobilization, strain-counterstrain, joint play, etc.) may provide relief when combined with exercise therapy.
- Intra-articular steroid injections can reduce inflammation and pain, but effects may be short-lived for some patients.
- Medial branch blocks can be used for both diagnosis and short pain relief.
Interventional treatment - Thermal Radiofrequency Ablation
For persistent pain unresponsive to conservative therapy, radiofrequency ablation (RFA) of the medial branch nerves is considered effective and can provide relief for 6–12 months in many patients. A prerequisite is two positive diagnostic Medial Branch Blocks of the suspected level.
Surgical treatment options
Surgically treatment is rarely indicated, but may be considered in refractory cases with severe pain and dysfunction, sometimes as part of broader spinal surgery with other pain entities as leading cause.
Adjunct Therapies
Platelet-rich plasma (PRP) injections and other regenerative approaches are being investigated, but evidence is still evolving.