Facet Arthropathy

Facet Arthropathy

One of the common and less often thought about causes of back and neck pain is facet joint arthropathy. These joints are located on both sides of the spine and enable one vertebra to hinge upon the one above and below them. These are true synovial joints similar to other joints in the body like the knees. A number of different processes such as trauma and normal aging can make these joints painful. Arthritis which is inflammation of the joints is not uncommon in these joints. This could be as a result of normal aging process or trauma to the neck and back. For example, whiplash injury to the neck after a car accident is relatively common cause of neck, shoulder, and upper arm pain coming from these joints. Sometimes, these joints can become hypertrophied (i.e. become bigger) and cause problems with spinal cord and nerve roots.

As many structures in the back and neck can cause pain, one needs to make certain as to where the pain is generated. Regular X-rays of the spine and even Cat scan and MRI are not very useful in determining if pain is coming from these joints. A patient may have a healthy looking joint on the film, but that does not necessarily mean that it is a non-painful joint. Conversely, a bad looking joint on a film does not necessarily mean that it should be painful. Aside from a thorough evaluation and physical exam, the most reliable test is diagnostic medial branch block which is commonly known a facet block. For more information on this, please check the "Procedures" section on the website.

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Important:

We would like to stress that fact that imaging studies such as CT or MRI usually could not provide helpful information for diagnosis of facet pain.

The gold standard in diagnosis remains medial branch block which is injection of local anesthetic under X-ray onto the nerves that supply sensation to these joints.

If your pain is significantly reduced during the test, then on can pinpoint the painful joints.

Radiofrequency facet rhizotomy later on could result in prolonged pain relief.