Cervical Facet Syndrome

What is Cervical Facet Syndrome?

Cervical facet syndrome is one of the commonest conditions in human population. The syndrome affects facet joints that bind the vertebrae and allow some movements. These joints are very vulnerable to inflammation and injury.

Facet joint inflammation may occur in any segment of the vertebral column, but the most common locations are cervical and lumbar part. It may develop as a consequence of a bad posture, injury, degeneration of the joints or repetitive movements.

Signs and Symptoms

• The main symptom of cervical facet syndrome is pain in the neck. The episodes of pain occur in episodes many times a year. The acute phase begins after exhaustion of the muscles, work in an uncomfrotable position or after injury. Pain is in acute episode always present, and may limit movements. After a certain period of time, depending on rest and treatment, the symptoms will diminish (usually after 3-4 weeks), only to appear again after a period without symptoms

• Pain may iradiate to shoulders, arms and even spread to fingers
• Movements are limited, mostly the extension of the neck backwards
• There is some tenderness and sensitivity when palpating the place of the pain.
• The paravertebral muscles may be in spasm and stiff to touch, which is a guarding mechanism that will revent further damage
• Some people also have neurological symptoms such as numbness, tingling or pricking along the neck, on one side, and in the shoulder or arms, or these symptoms may spread to the fingers. This happens if the inflammation and swelling compress the nerves from the cervical portion of spinal nerves. ⁽¹⁾

Diagnosis

This condition should be differentiated from the herniated disc. The diagnosis is made with X-ray and MRI.

Treatment

It is important to improve posture in order to prevent the pain. Sitting in an uncomfortable position in front of the computer, in inappropriate conditions, may be the reason for development of this disorder. Improving the office conditions can be beneficial, for example, the monitor of the computer needs to be in level of the eyes.

The keyboard and mouse need to placed as lower as possible so that the arms wouldn’t be in a stiff position, but rather just relaxed on the table. You should remind yourself to avoid slumping position. The monitor should be approximately 50-100 cm from your eyes, so that you don’t need to lean back or to the front to read something. The arms need to be relaxed and on the table or on the supporters.

This way, arms are relaxed and muscles of the neck, especially trapezius is not under such great pressure as when arms aren’t supported and are in the air. The chair has to be comfortable and without wheels, so that you can lean back from time to time to relax. Feet need to be relaxed as well, and placed on a small stool, because that relaxes the muscles of the whole vertebral column.

Head needs to be moved left-right from time to time, to avoid stiffness of the muscles and overuse of the facet ligaments. Avoid holding the phone with your neck.

It is also important to improve the conditions of sleeping. Sleeping pillow should be adapted to your neck condition. The pillow shouldn’t be too soft nor too firm. Avoid falling asleep in the chair in front of the TV, or watching TV while laying down with head raised above, this too may be the reason for pain.

Another important measure is to exercise every day. Doing so and moving the neck to the left and right, up and down, rotating it, strengthens the muscles so that they can handle great pressure. These exercises should be performed at least three times a day for 10-15 minutes, with relaxational exercises. These exercises should be ordered from a physical therapist. Some other measures in physical medicine can also help in pain relief.

It is also helpful to use analgesic creams. These creams contain NSAID (Non-steroid anti-inflammatory drugs). Their mechanism of action is to clean to area underneath from the inflammatory mediators, such as prostaglandins and mediators that trigger the sensation of pain (bradykinin). They also improve circulation on site which allows healing. If the nerves are affected it is indicated to use medications for neuropathic pain (gabapentin, pregabalin). Other most commonly used are muscle relaxants, COX2 inhibitors,

When the pain first appears, it is actually better to apply cold, to reduce swelling. There are creams with menthol that can provide such effects. Later as the healing begins, there is a need to improve circulation, which can be done with heating patches, or creams ( with Capsaicin).

If the cervical facet syndrome appeared because of the injury there might be indications for injection or surgery. If the nerves are compressed by the inflamed tissue, there might be some benefit from the percutaneous radiofrequency neurotomy.

Recovery phase begins when the person is almost without pain, or experiencing mild pain. In this phase it is good to apply massage therapy and exercises. ^{(2) (3)}

References:

1. Ray CD. Symptoms and Diagnosis of Facet Joint Problems. spine-health. [Online] 2002. [Cited: 3 9, 2017.] http://www.spine-health.com/conditions/arthritis/symptoms-and-diagnosis-facet-joint-problems.
2. Cervical Facet Joint Syndrome. The Blackberry clinic. [Online] [Cited: 3 9, 2017.] http://www.blackberryclinic.co.uk/articles/156-cervical-facet-joint-syndrome.
3. RE., Windsor. Cervical Facet Syndrome Treatment & Management. emedicine medscape. [Online] 11 6, 2014. [Cited: 3 9, 2017.] http://emedicine.medscape.com/article/93924-treatment#d11.