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Facet Joint Pain

 

Facet Joint:

Your spine has a complex consistent vertebrae/bones, discs, joints, ligaments, nerves, spinal cord all of which collectively are called "spine . Individual on your spinal cord vertebrae.  The vertebrae is intact like Lego pieces.  In fact, does not radiate by a disc.

 

In the back, every two adjacent vertebrae will connect with pair of Facet joints ( zygapophyseal joint).  There is one facet to the left of the center and one facet is to the right of center at each segment of your spine.  When you bend and twist, your facet joint allows for that motion.  Approximately 15 to 20% of all back pain is related to the facet joint.  Either due to trauma or simple aging, the facet joints can become arthritic, and become painful.  As result, you may develop neck pain, mid back pain, lower back pain.

 

Most individuals report worsening of pain with twisting and turning the spine to the affected side or extending the spine such as looking up to the ceiling or arching the back.  Facet pain is often steady, moderately painful and symptoms may fluctuate during the day and with changes in temperature or humidity.

  • In the neck, facet pain could create just neck pain (often one sided), or neck pain with headaches or neck pain with pain inthe shoulder blade area.  

  • In the lower back, it may localize to one or the other side of the spine or may radiate to the buttock and the flank and at times to the groin.

  • The facet pain in the mid back often stays localized or may gravitate towards the rib.   Facet pain is managed medically and there is no surgical solution.

 

Diagnosis:
Clinical exam, history, and basic x-rays should be sufficient for initial diagnosis of neck to mid back or lower back pain.  If response to physical therapy and NSAIDs are minimal, often your provider will obtain an MRI as well to rule out other coexisting conditions.  The best diagnostic tool to determine whether the facet joints are the source of pain is either a anesthetic injection of the facet joint or anesthetic block of the nerve adjacent to the joint (Media branch block).

Treatments

  • Conservative CarePhysical therapy and anti-inflammatory medications are the starting point for treatment.  Some patients benefit from chiropractic adjustments, Accupuncture and soft tissue massage.  Opioids are not indicated for back pain particularly if it is chronic . 

  • Procedures: If the pain does not subside, facet joint steroid injection (Cervical or Lumbar) , facet joint medial branch RF ablation  (Cervical or Lumbar), and facet joint PRP injection can be offered.  Outcome of the facet treatments are often satisfactory with reduced pain and improved function.  (Read more)

  • Surgery is not indicated for visit joint pain although there is fracture or dislocation

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