Facet joints occur in pairs at the back of each vertebra. The facet joints link the vertebrae directly above and below to form a working unit that permits movement of the spine. The structure of the facet joint is identical to other joints in the body, such as knees and hips.
The bone surfaces of the facet joints are covered with a specialized tissue called articular cartilage. The joint is lined by a membrane called the synovium and enclosed in a fibrous sac called a joint capsule. A thick liquid (synovial fluid) surrounds the joint, allowing the bones to move without friction.
Facet joint syndrome refers to pain that occurs in the facet joints. This syndrome most often affects the lower back and neck. Lumbar facet syndrome might cause referred pain to the buttocks and thigh. Facet syndrome in the neck might cause headaches or shoulder pain.
What are the symptoms of facet joint syndrome?
Symptoms of facet joint syndrome in the lower back include:
- Pain or tenderness in the lower back
- Pain that increases with twisting or arching the body
- Pain that moves to the buttocks or the back of the thighs — This pain is usually a deep, dull ache.
- Stiffness or difficulty with certain movements, such as standing up straight or getting up out of a chair
Symptoms of facet joint syndrome in the neck include:
- Neck pain
- Headaches
- Shoulder pain
- Difficulty rotating the head
What causes facet joint syndrome?
There are several possible causes of pain that originates in a facet joint. An injury and/or changes associated with aging might cause the cartilage cushion that covers the bones to wear away, causing pain as the bones of the joint rub together.
In addition, small nerves that branch out from the spinal nerves supply the facet joints. Irritation or pinching of these nerves also can lead to pain. Poor posture, which forces the spine out of alignment, can be a factor in the development of pain from the facet joints. Trauma, inflammation, infection, and disc degeneration are other suggested causes of facet joint pain.
How common is facet joint syndrome?
Facet joint syndrome is more common in the elderly, as changes to the joints associated with aging are present in most people over 50 years of age.
How is facet joint syndrome diagnosed?
Often, a health care provider will suspect facet joint syndrome after an evaluation that includes a complete medical history and physical examination. The health care provider might order an X-ray, computed tomography (CT) scan of the spine, or magnetic resonance imaging (MRI) scan to rule out another disorder — such as a fractured or herniated disc — as the cause of the pain.
A procedure called a facet joint block might be done to determine if the facet joints are the source of the pain. A facet joint block involves injecting a numbing medicine into or very near the nerves that supply the facet joint. Facet joint syndrome is confirmed if there is a significant decrease (50 percent or more) in pain after the joint has been numbed. If the pain is not relieved by the injection, it is unlikely that the facet joint is the source of the pain.
How is facet joint syndrome treated?
Facet joint syndrome most often is treated with a combination of non-surgical methods, including:
Posture correction
Keeping the spine in proper alignment can reduce stress on the lower back and neck.
Activity modification
This might include altering your home and workplace environments to avoid excessive twisting, stretching, and bending. Using proper lifting techniques also is important for protecting the back and neck.
Exercise/physical therapy
The goal of exercise and/or physical therapy is to reduce pain and inflammation, and increase pain-free movement. Exercise also increases circulation, which aids healing. It also improves flexibility and builds strength.
Medicines
Medicines can help relieve pain, and reduce inflammation and muscle spasms. An over-the-counter non-steroidal anti-inflammatory drug (NSAID), such as Motrin, might be recommended to help reduce pain and swelling. Stronger medicines might be prescribed if the NSAIDs do not provide relief. These medicines might include pain medicines and muscle relaxants. These medicines can have side effects, including nausea, headaches, and sleepiness.
If a facet block confirms the facet joint as the primary source of pain, a more long-term treatment might be needed.
When non-surgical treatment fails, a surgical procedure called radiofrequency rhizotomy might be necessary to relieve pain and improve mobility. Radiofrequency rhizotomy, also called radiofrequency neurotomy, is the surgical "de-nerving" of the facet joint.
The doctor uses a special X-ray connected to a monitor to accurately place a needle with a small electrode into the facet joint. An electric current is used to destroy the sensory nerves of the joint, leading to pain relief.
What is the outlook for people with facet joint syndrome?
An active rehabilitation program — including anti-inflammatory medicine, physical therapy, and activity modification — often is enough to help a person with facet joint syndrome become pain-free. About 80 percent of people who have facet nerve blocks experience good to excellent relief that can last for several months.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 5/11/2006...#10276
