Facet Joint Pain
In certain cases lumbar pain can been attributed to the facet joints, the sacroiliac joints, spinal nerve roots, muscles and ligaments, and other non-vertebral causes.
In the cervical spine, the facet joints are actually the most common source of pain. Neck pain is attributed to facet joint dysfunction more often than a disc herniation or to a dysfunctional intervertebral disc, combined.
Clinically the correct term for the facet joints is the zygapophysial joints. Each spinal level has a pair of facet joints. The main role of these joints is to help guide the motion of the spine.
Each facet joint is innervated by two nerves (specifically the medial branch of the primary dorsal rami). These sensory nerves actually transmit the signal of pain from our facet joints to our spinal cord, plays a vital role in both the diagnosis and treatment of neck and back pain from the facet joints.
The above cross section of the spinal column anatomy illustrates the path of the medial branch nerve (blue arrow). It is this nerve that provides sensation to the facet joint. Each facet joint is innervated by two medial branch nerves. These nerves signal pain in the joints themselves.
Signs and Symptoms
Lumbar spine. Low back pain that is derived from the lumbar facet joints can present in many ways. There is some overlap between pain from the facets joints and that of other spinal structures. Dr. Pablo Pazmiño may develop a high suspicion of facet joint pain after listening to your history and performing a physical exam; however, research has shown that it is impossible to reliably make a diagnosis without further diagnostic testing.
Thoracic spine. Mid back pain that is derived from the facet joints is also possible. When it does occur it often presents with pinpoint pain along the spine. Movements such as lateral bending or lateral rotation, or even overhead lifting may exacerbate your symptoms. It is impossible to make a concise diagnosis from the original office assessment. Dr. Pablo Pazmiño may develop a high suspicion of facet joint pain after listening to your history and performing a physical exam; however, research has shown that it is difficult to reliably make a diagnosis without further diagnostic testing.
Cervical spine. Neck pain that is derived from the cervical facet joints is actually very common! Research studies show that the cervical facet joints may actually be the most common source of neck pain. However, similar to the lumbar spine, there exists some overlap between pain from the facets joints and that of other spinal and non-spinal structures. (e.g. intervertebral discs, spinal nerves, upper back muscles, muscles, TMJ, etc.) Dr. Pablo Pazmiño may develop a high suspicion of facet joint pain after listening to your history and performing a physical exam.
During your consultation, Dr. Pablo Pazmino will take a complete medical history to rule out other conditions that can cause symptoms similar to cervical herniations. Dr. Pablo Pazmino will also perform a complete and thorough physical examination. Radiography (X-rays) and other diagnostic imaging tests (MRI) will then be reviewed so that Dr. Pablo Pazmino can evaluate your bony quality, any instabilities, herniations causing any neural compression, bony spurs or other abnormalities to reveal the extent of damage to your cervical spine.
At Santa Monica Spine we pride ourselves in our duty to educate our patients. Dr. Pablo Pazmino uses his background as a teacher to ensure that you understand your pathology, imaging and treatment options completely during each visit. Our patients often comment on their amazement at the amount of time and effort we take to review their studies, often in a manner which they have never seen before. We want our patients to be involved in every step of the process and we feel that education is the first step towards achieving that goal together.
At Santa Monica Spine / Beverly Spine we are very thorough. Dr. Pablo Pazmiño will need a complete history of any medical illnesses, surgeries, or chronic conditions which you may have or for which you have seen other physicians in the past.
More specifically we will require a history of your back and leg pain itself. What is the exact location of the pain? When did the problem begin? What does the pain feel like? Has your back been injured before? Have you previously been treated for back or leg pain?
One must recognize that imaging studies only provide anatomic detail and cannot independently determine the particular source or cause of pain. There are no radiographic studies available at present which allow Dr. Pablo Pazmiño to conclusively diagnose facet joint pain. Various studies may reveal anatomic abnormalities of the spine. However, they are not diagnostic. Due to the fact that pain is a subjective experience, Dr. Pablo Pazmiño must carefully assess the history and correlate it with the imaging studies. Dr. Pablo Pazmiño uses plain radiographs, CT, CT myelography, MRI, bone scans and SPECT can be utilized to provide additional anatomic detail. They can also alert the physician of malignant causes of spine pain.
Nonsurgical treatment is effective in treating the symptoms of neck pain. Symptoms of neck pain may last for days, several months, or become chronic. If symptoms are mild, Dr. Pablo Pazmino may recommend a variety of nonsurgical treatments.
- Rest. A soft cervical collar or neck brace may be used to limit neck motion and relieve irritation.
- Bracing. A course of Bracing may help preserve overall posture and may give the vertebral bodies a supporting environment in which to heal.
- Medication. Dr. Pablo Pazmino may prescribe nonsteroidal anti-inflammatory medications (NSAIDs) or other non-narcotic pain relievers to relieve your pain and reduce swelling. Muscle relaxers, analgesics, and anti-inflammatory medications are also helpful.
- Acupuncture. Dr. Pablo Pazmino works with a team of Acupuncture specialists and may recommend this if indicated for your symptoms.
- Chiropractic Management. Dr. Pablo Pazmiño works with a reliable team of Chiropractors and may recommend this if indicated for your symptoms.
- Physical therapy.A course of therapy guided by Dr. Pablo Pazmiño may include hot and cold therapy, ultrasound or an active exercise program which may help relieve symptoms. Exercises may include core body strengthening, lumbar and lower extremity stretching, and aerobic exercises. Patients may also receive gentle massage and perform activities to improve posture.
- Injections: A series of selective nerve root blocks or epidural injections of a cortisone-like drug may lessen nerve irritation and allow more effective participation in physical therapy. These injections are given on an outpatient basis over a period of weeks. Dr. Pablo Pazmiño only works with a small group of physicians who he trusts to perform these injections. Click here to see some of the recommendations Dr. Pablo Pazmiño makes in
Nonsurgical treatment may take away most of the symptoms, but it does not treat the underlying structural cause. Follow-up visits are necessary so Dr. Pablo Pazmiño can check if symptoms have gotten better, worse, or have stayed the same.
Diagnostic Injectionsregards to injections and pain management physicians.
Dr. Pablo Pazmiño may recommend a team of physicians who may use intra-articular (joint injection) or medial branch blocks (nerve blocks) for the facet related pain. If Dr. Pablo Pazmiño suspects that your back or neck pain is emanating from the facet joints, he may order a diagnostic injection series to confirm this suspicion. Under live x-ray guidance,a local anesthetic is precisely injected to block the nerves that give sensation to the joint in question (medial branch block). If this provides complete or near complete relief of your neck pain, it is likely that the facet joint is causing some component of your pain. However, if you obtain good relief, the block must be repeated a few days later, with a different medication. This is done to make sure your response to the original block was not a false-positive result ("placebo effect"). Believe it or not the rate of false-positives is close to 40%!
Various treatment options are available for facet joint pain.
Radiofrequency neurotomy. The standard of care is a radiofrequency neurotomy. Facet neurotomy is a procedure procedure that interrupts the pain signal through a facet joint's nerve. A radio-frequency probe that heats the 2 small nerve branches to each facet joint accomplishes this interruption known as denervation.
Intra-articular steroid injection. There are a definite percentage of patients who suffer from joint pain that will respond the instillation of corticosteroids into the affected joint(s). This is a quick, safe procedure that is easy to tolerate. However it is typically only recommended in select patients because the results from this procedure do not measure up to those of radiofrequency neurotomy.
- Education and training in proper body mechanics and posture are essential.
- Strength training. A sound foundation for your spine to work from will help with long-term results. Gaining stability in your pelvic and shoulder girdles will set you up for sustained benefit from your facet neurotomy.
- Aquatic therapy. Water based exercises can also be instituted for relief of facet joint pain.
When Should You Seek Medical Care?
If severe pain occurs following an injury (motor vehicle accident, diving accident, or fall), a trained professional, such as a paramedic, should immobilize you to avoid the risk of further injury and possible paralysis. Emergent medical care should be sought immediately.
Immediate medical care should also be sought when an injury causes pain in the neck that radiates down the arms and legs.
Radiating pain, or numbness in your arms or legs which causes weakness in the arms or legs without significant neck pain should also be evaluated.
If there has not been an injury, you should seek a Spinal Evaluation with Dr. Pablo Pazmino when pain is:
- Continuous and persistent
- Accompanied by pain that radiates down the arms or legs
- Accompanied by headaches
- Accompanied by numbness, or tingling
- Accompanied by weakness!
Many patients seek care for Facet Joint Pain by Dr. Pablo Pazmiño because as an Orthopaedic surgeon he is specifically trained to diagnose, treat, and help prevent problems involving the muscles, bones, joints, ligaments, and tendons. Although Dr. Pablo Pazmiño confines his practices to Spinal pathology he also treats a wide variety of diseases, injuries, and other conditions, including Osteoporosis.