In-Depth Exploration of Cervical Facet Pain

Pain from the cervical facet joints, either due to degenerative conditions or due to whiplash-related trauma, is very common in the general population. A literature review by Helinga et al. published in Pain Practice discusses the diagnosis and treatment of cervical facet-related pain with special emphasis on interventional treatment techniques.

Neck pain, a prevalent issue affecting up to 48.5% of individuals throughout their lives, continues to be a significant health challenge. In many cases, over 50% of individuals presenting with neck pain to clinics, the cervical facet joints are identified as the primary source of discomfort.

Cervical facet pain is a significant source of discomfort and dysfunction, commonly arising from the facet joints in the cervical spine. These joints, technically known as zygapophyseal joints, play a crucial role in the mobility and stability of the neck. Understanding cervical facet pain involves examining the anatomy, causes, symptoms, and treatment approaches.

Anatomy of Cervical Facet Joints

The cervical facet joints are diarthrodial, synovial joints between the articular processes of two adjacent cervical vertebrae. They are oriented in a way that allows a wide range of motions, including extension, flexion, rotation, and lateral flexion of the neck. This orientation, however, also predisposes these joints to both degenerative changes and injury.

Causes and Mechanisms of Cervical Facet Pain

Cervical facet pain can originate from several sources:

• Degenerative Changes: Like other joints in the body, cervical facet joints can undergo degenerative changes due to aging, leading to osteoarthritis. This degeneration can result in a decrease in the joint space, increased mechanical stress, and pain.
• Trauma: Acute injuries from sports, accidents, or sudden movements can cause damage to the facet joints. Whiplash injuries, where the head is suddenly jerked forward and then back, are a particularly common cause of trauma to these joints.
• Overuse: Repetitive movements and poor postural habits can lead to overuse injuries of the cervical facet joints, resulting in inflammation and pain.

Symptoms of Cervical Facet Pain

The symptoms associated with cervical facet pain can vary but typically include:

• Localized Pain and Tenderness: Pain is usually localized to the area of the affected facet joint and can be exacerbated by certain movements like extending or rotating the neck.
• Referred Pain: Cervical facet pain can refer pain to other areas, such as the head, shoulders, and upper back. This referred pain can sometimes mimic conditions like migraines or shoulder bursitis.
• Stiffness and Reduced Mobility: Individuals with cervical facet pain often experience stiffness in the neck, which can limit their range of motion and affect daily activities.

Diagnostic Techniques

Diagnosis of cervical facet pain typically involves:

• Physical Examination: Clinicians will look for tenderness over the affected joints, pain with certain movements, and signs of nerve irritation.
• Imaging Studies: X-rays, CT scans, and MRIs can help visualize changes in the facet joints, though imaging alone often does not confirm the pain source, and not recimmended.
• Diagnostic Blocks: The most definitive method for diagnosing cervical facet pain involves performing medial branch blocks. These blocks involve injecting a local anesthetic near the nerves that innervate the facet joints. If the pain resolves temporarily after the injection, it suggests that the facet joints are the pain source.

Treatment Options

Management of cervical facet pain may include:

• Conservative Treatments: Initial treatment often involves physical therapy focusing on strengthening and stretching exercises to improve flexibility and reduce stress on the joints. Manual therapies, heat/ice application, and anti-inflammatory medications can also help manage symptoms.
• Interventional Procedures: For cases where conservative treatments are insufficient, procedures like radiofrequency ablation (RFA) or medial branch blocks can be effective. RFA uses heat generated by radio waves to disrupt nerve function and block pain signals.
  For chronic facet joint pain, evidence for pharmacological treatment is lacking. Treatment with botulinum toxin, intra-articular steroid injections, or surgery are not recommended.
• Lifestyle Modifications: Educating patients on posture and ergonomics can help prevent further joint stress and alleviate pain.

Long-term Management

Chronic management may require a combination of therapies tailored to the individual’s symptoms and response to initial treatments. Regular follow-up and adjustments to the treatment plan are crucial for effectively managing cervical facet pain.

For manual therapists, a deep understanding of cervical facet pain enriches their toolbox, enabling them to offer more targeted and effective interventions for patients suffering from this challenging condition.

Conclusions: Cervical facet pain is diagnosed based on history, physical examination, and a diagnostic block of the medial branches innervating the painful joints. Conservative management, including exercise therapy, is the first line of treatment. When conservative management does not result in adequate improvement of pain, radiofrequency treatment of the medial branches should be considered, which often results in adequate pain relief.