1. Facet joint syndrome Orthopaedic surgery department Afif general hospital By Dr. Ahmed Abdel-Ghani Orthopaedic specialist
2. Introduction : Each vertebra has two sets of facet joints. One pair faces upward (superior articular facet) and one downward (inferior articular facet). There is one joint on each side (right and left). Facet joints are hinge–like and link vertebrae together. They are located at the back of the spine (posterior). Facet joints are synovial joints. This means each joint is surrounded by a capsule of connective tissue and produces a fluid to nourish and lubricate the joint. The joint surfaces are coated with cartilage allowing joints to move or glide smoothly (articulate) against each other.
3. Anatomy: The facet joints are synovial joints, structures that allow movement between two bones. The ends of the bones that make up a synovial joint are covered with articular cartilage, a slick spongy material that allows the bones to glide against one another without much friction. Synovial fluid inside the joint keeps the joint surfaces lubricated, like oil lubricates the parts of a machine. This fluid is contained inside the joint by the joint capsule, a watertight sac of soft tissue and ligaments that fully surrounds and encloses the joint.
5. Facet Joint Syndrome What is it? Facet joint syndrome most often affects the lower back and neck and refers to pain that occurs in the facet joints, which are the connections between the vertebrae in the spine that enable the spine to bend and twist. Like other joints in the body, facet joints can get inflamed and cause pain and stiffness. 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. People who suffer from this problem typically complain that they walk in a hunched-over position.
6. What causes it? One of many possible causes is imbalances that can occur in stress levels, hormone levels, and nutritional levels. These imbalances can adversely affect posture, which can lead to neck and back pain. Other causes include trauma or disc degeneration due to aging, either of which may cause the cartilage cushion that covers the bones to wear away, producing pain as the bones of the joint rub together. Pinching of the nerves that serve the facet joints also can lead to pain.
7. What are the symptoms? Facet joint syndrome tends to produce pain or tenderness in the lower back that increases with twisting or arching the body, as well as pain that moves to the buttocks or the back of the thighs. This pain is usually a deep, dull ache. Other symptoms include stiffness or difficulty standing up straight or getting out of a chair. People who suffer from this problem typically complain that they have to turn their entire body to look over to the right or left. Pain can be felt in other areas such as the shoulders or mid-back area.
8. How is it diagnosed?: A complete medical history and physical examination should be done by a health professional, which may include an x-ray, computed tomography (CT) scan of the spine, or magnetic resonance imaging (MRI) 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 may also be done. This involves injecting a numbing medicine into or near the nerves that supply the facet joint. If the pain is not relieved by the injection, it is unlikely that the facet joint is the source of the pain.
9. What are the most common treatments? Commonly used drugs include acetaminophen (Tylenol), non-steroidal anti-inflammatory drugs (NSAIDs), and opiods such as codeine and morphine. Non-drug treatments include hot packs, ultrasound, electrical stimulation, and therapeutic exercises. Stimulating blood flow using massage or a hot tub may also help. Alternative treatments include yoga and relaxation therapy. If your pain persists after trying these treatments, a surgical procedure called radiofrequency rhizotomy, which destroys the sensory nerves of the joint, may bring relief.
10. Why do traditional treatments fail? Most traditional treatments fail to provide long-term relief because they merely address the symptoms and fail to address the cause of the condition. Unless the cause is fully understood, trying to get rid of the problem becomes a guessing game. One thing is certain: No treatment has been found to be the "one thing that works for everyone."
11. Which treatments work best? Facet Joint Syndrome is fairly common contributing factor to back pain and because the facet is a joint a combined approach will be beneficial in this case. For example, Inversion Therapy can be very effective in reseating the facet joints and by use Muscle Balance Therapy you can restore the normal articulation of the joint and thus eliminate your symptoms and return proper function. In most cases of Facet Joint Syndrome, Inflammation and Trigger Points will be associated with this condition and thus it is recommended that you research Trigger Point Therapy and we recommend that you look in to an alternative approached to addressing your inflammation and Enzyme Therapy is one such considerations for you.
