Diagnosis and Treatment of Facet Joint Injuries
Facet Joint injuries are injuries to the small supporting joints in the cervical, thoracic, and lumbar spine. They can be injured as part of a motor vehicle accident or fall. The direct trauma to the spine during these injuries can dislocate, fracture or inflame the joint and bones that make up this delicate joint. Facet joint injuries make up one of the more common causes of chronic and disabling back and neck pain. Patients with facet joint injuries tend to have significant pain even though it is rare to have involvement of the spinal nerves.
Diagnosing a facet joint injury can be complicated because the symptoms are so similar to the symptoms seen in a herniated disc, a bony fracture, torn muscles or ligaments of the spine or even an infection of the spine. Even intra-abdominal injuries can mimic lumbar facet joint injuries. In the cervical area, injuries to the deep anterior portion of the neck can feel like facet joint dysfunction. Acute injuries to the facet joints can be superimposed upon chronic arthritic changes in the facet joints.
Facet Joint Injury Symptoms
In the presence of a history of trauma, one can suspect that a facet joint injury has happened because of the following symptoms:
- Intermittent and unpredictable spinal pain that recurs several times per month following the injury.
- Point tenderness in the neck or back when pressing on the involved facet joints. The facet joints are relatively close to the surface of the back so they can be directly palpated and are tender when touched.
- Pain is usually worse when the patient is leaning backwards and somewhat relieved by leaning forward.
- The pain radiates to the buttocks if the facet joints in the lumbar spine and can radiate down the back portion of the upper thighs. The pain does not radiate past the knees, which is the case if the pain is from a disc herniation.
- In the cervical area, facet joint injuries can radiate to the upper back or shoulders but doesn’t radiate down the arm as would be seen in radicular pain stemming from a herniation injury to the neck.
Because the pain is intermittent and somewhat unpredictable, some patients are led to believe that the pain isn’t real and that it is psychosomatic in nature. Standing tends to be easier than sitting; sitting and riding inside a vehicle are especially painful. Interestingly, putting these patients on light duty or sitting activities, tends to make the problem worse. Muscle spasm is common while sitting and this sets up a chronic sort of pain that is both muscular and joint/bone in nature.
Diagnosis of Facet Joint Injuries
- Facet joint fractures, dislocation or degeneration may be achieved through regular x-rays of the spine, CT scan of the spine, or through an MRI evaluation of the spinal segments involved. Plain x-rays, especially when AP, lateral and oblique x-rays are taken, can show areas of facet joint degeneration or fracture. CT scan is, however, preferable because it can show areas of damage not only to the facet joints but to other areas of the spine, including the spinal discs. MRI scan is less helpful in facet joint injuries but can be helpful if the problem involves the spinal discs.
- There is another way of definitively showing facet joint pain. It involves injecting the suspected facet joint with a combination of local anesthetic, cortisone, and x-ray contrast dye. This facet joint block can relieve the pain of the facet joint injury immediately because of the injected local anesthetic and is diagnostic of facet joint dysfunction. The injectable cortisone can relieve the inflammation of the joint, at least for a period of time.
- Treatment of Facet Joint Injuries
Facet joint injuries can be treated with or without surgery. Treatments of inflamed facet joints can involve physical therapy treatments, most of which are temporary in effectiveness. The long term effectiveness of any treatment for facet joint injuries is lacking, however.
Some treatments that will temporarily help facet joint injuries include the following:
- Physical therapy exercises aimed at reducing muscle spasm and joint inflammation. Physical therapy can also involve the use of heat or cold to relieve inflammation or spasm of the muscles.
- Using correct posture when standing and sitting. This means bending the knee slightly when standing for long periods of time (and putting the foot on a small stool). While sitting in a car, a back support can correct abnormalities in posture so that the normal curvature of the lumbar and thoracic spine can be maintained.
- Practicing the pelvic tilt activity by pinching the buttocks together and by rotating the pelvis forward. This can be repeated several times daily for as long as it is effective in reducing the pain.
- Heat wraps or a hot water bottle can be applied to the affected area. Some people respond better to cold treatments, especially when the pain is very serious.
- Cutting out long car rides or bus rides; taking frequent rest breaks from sitting activities can reduce the level of pain.
- NSAID medication, such as ibuprofen or naproxen or the use of COX-2 inhibitors like Celebrex® can reduce the inflammatory component of the pain.
- Chiropractic treatment. Certain chiropractic manipulations can realign subluxations of the cervical or lumbar facet joints for temporary relief of symptoms.
- A cervical collar can be used to support the facet joints of the cervical spine, providing traction to the cervical spinal area. Supportive pillows that put the neck in its normal anatomical position can help relieve the pain. Too many pillows on the neck should not be used as this will worsen the pain.
- Facet joint rhizotomy can be performed. This involves using a cold tip and freezing some of the nerve endings or using an electrocautery technique and burning some of the nerve endings around the affected facet joints. This is done using x-ray to detect where the facet joints and nerve endings are located.
- Botox injections of the spinal area can reduce the spasm of the surrounding muscles and therefore can reduce the pain.
Because the facet joints are so delicate and important in the support and movement of the back and neck, any injury is likely to contribute to joint degeneration and chronic pain in the facet joint injury sufferer.
I’m Ed Smith, a Sacramento Personal Injury Lawyer with extensive experience in handling facet joint injuries. Call me anytime at 916-921-6400 for free, friendly advice. Outside of Sacramento call me at 800-404-5400.