What are signs and symptoms of Facet Arthritis?

Signs and symptoms of facet arthritis include: - Pain after quick twisting or bending of the spine, often associated with lifting or sudden movements. - Pain usually felt in the neck or back, and sometimes extends into the arms or legs. - Pain spreading can vary based on the location of arthritis in the spine: - Upper part of the neck: Pain spreads to the back of the head and may cause headaches. - Lower part of the neck: Pain spreads down to the shoulders and area between the shoulder blades. - Lower back: Pain affects the buttock and thigh areas, rarely extending beyond the knee. - Unlike other types of spinal pain, facet arthritis pain doesn't usually include symptoms like loss of motion, sensation, or reduced reflexes. - Signs of facet arthritis can be spotted during a physical examination: - Tenderness over the affected part of the spine. - Pain that worsens when stretching or twisting but is relieved by bending forward. - The Kemp test is one test for facet arthritis, where the person is asked to stretch and twist their spine. If this movement causes their usual pain, the test is considered positive for facet arthritis. However, this test doesn't always accurately diagnose the condition according to some research.

How do you get Facet Arthritis?

Facet arthritis can occur due to an injury or bad posture that puts extra pressure on the back part of the spine.

What else can Facet Arthritis be?

The doctor needs to rule out the following conditions when diagnosing Facet Arthritis: 1. Herniated disc that's squeezing the nerve roots 2. Pain caused by problems with a spinal disc, including its inner material bursting out 3. Radiculopathy, a nerve issue that leads to pain, weakness or numbness 4. Injuries to the muscles and ligaments in your trunk or lower back 5. Spondylolysis or spondylolisthesis, two different types of spine conditions 6. Piriformis syndrome, a type of buttock pain 7. Injury to the sacroiliac joint, which connects the spine to the hips 8. Compression of the superior cluneal nerve, a nerve in the lower back 9. Dysfunction in the thoracolumbar fascia, a layer of connective tissue in the lower back 10. Inflammatory arthritis of the spine, like rheumatoid arthritis or ankylosing spondylitis 11. Infection in the spine 12. Tumor in the spine

How is Facet Arthritis treated?

Treatment options for facet arthritis can include physical therapy, pain medications, spinal manipulation, specific kinds of injections, radiofrequency treatment, and surgery. Physical therapy can provide education on maintaining proper posture and using the body correctly, while pain medications can be used to treat sudden onset of severe pain or flare-ups of chronic pain. Spinal manipulation can correct certain types of facet joint issues, and injections of anesthetic can be used to treat pain associated with facet joint inflammation. Radiofrequency lesioning can be applied for pain that is resistant to previous treatments. Surgery is considered when the pain is unmanageable or accompanied by severe complications.

Are there long term effects of Facet Arthritis?

The prognosis for Facet Arthritis is as follows: - With one to three treatments, patients experienced total pain relief for one to three months. - 82% of the patients had relief for four to six months. - 21% recorded relief for seven to twelve months. - Only 10% continued to feel pain relief after 12 months.

What type of doctor should I see for Facet Arthritis?

You should see a doctor specializing in rheumatology or orthopedics for Facet Arthritis.

Facet Arthritis

Facet joints are joints in your spine formed where two neighboring vertebrae (the bones in your spine) meet. Except for joints located at the top of the spine (the atlantooccipital and atlantoaxial joints), these facet joints have a lining called synovium and are protected by a joint capsule. This capsule has a lot of nerve endings, making them sensitive.

Interesting to note, each facet joint gets its nerve supply from two spinal levels. One comes from the nerve branch at the same level of the joint, and the other from one level above. This can make it tricky to pinpoint exactly where facet-related pain is coming from.

You can think of the spine as a set of linked parts that can move. In each moving part, the upper joint process of the lower back bone links with the lower joint process of the upper back bone. Therefore, how the spine lines up and how weight is distributed on it can have a substantial role in the wear and tear of the facet joints, which are small stabilizing joints located between and behind adjacent vertebrae.

If the spine becomes unstable due to an injury or bad posture, which puts extra pressure on the back part of the spine, this could also lead to the wearing out of the facet joints.

Facet arthritis is a condition that primarily affects older individuals. According to a study by Manchikanti and colleagues, facet joint involvement is present in 35% to 42% of patients who suffer from neck pain. For those with pain in the lower back or lumbar region, the prevalence of facet arthritis varies from 18% to 44% across all age groups.

Facet arthritis often results in pain after quick twisting or bending of the spine, often associated with lifting or sudden movements. The pain is usually felt in the neck or back, and sometimes extends into the arms or legs. The way this pain spreads can vary based on where in the spine the arthritis is located:

Upper part of the neck: Pain often spreads to the back of the head and may cause headaches.
Lower part of the neck: Pain can spread down to the shoulders and area between the shoulder blades.
Lower back: Pain often affects the buttock and thigh areas, and rarely extends beyond the knee.

It’s worth noting that unlike other types of spinal pain, this pain doesn’t usually include symptoms like loss of motion, sensation, or reduced reflexes. Signs of facet arthritis can be spotted during a physical examination: Tenderness over the part of the spine affected by the arthritis, and pain that gets worse when stretching or twisting but is relieved by bending forward can both be indicators.

One test for facet arthritis is the Kemp test. In this test, the person is asked to stretch and twist their spine. If this movement causes their usual pain, the test is considered positive for facet arthritis. However, this test doesn’t always accurately diagnose the condition according to some research.

Understanding whether arthritis in the back joints is causing your pain involves making sure that other conditions like slipped discs, spinal narrowing, infection, vertebra slipping (spondylolisthesis), and tumors of the spine are not the cause. It’s not uncommon for people to have arthritis in these back joints at the same time as these other conditions.

Various imaging tools like x-rays, CT scans, and MRIs can be used to look at the affected joints and rule out or identify other possible conditions. These tools can also help assess the degree of degeneration in these joints.

A CT scan is the most effective tool for identifying arthritis in these joints. The MRI, on the other hand, is very good at providing clear images of the soft tissues around the spine such as the discs, the spinal cord itself, the openings in the spine where the nerves exit (neuroforamen), and the nerve roots. Regular x-rays can also be useful, allowing doctors to see if there’s any instability in the spine when you flex or extend.

Certain invasive techniques can also be useful in determining your diagnosis. These include the use of injections (facet block) into the joints or the nerves that supply these joints to help confirm if these joints are the source of your pain.

Treatment options for pain arising from the degeneration of the facet joints (the flexible joints that link the spine’s bones together) can include physical therapy, pain medications, spinal manipulation, specific kinds of injections, radiofrequency treatment, and surgery.

Physical therapy can provide education on maintaining proper posture and using your body correctly. It’s best to avoid positions that involve too much bending backwards or twisting of the spine. Strengthening exercises targeting the deep muscles at the front of the neck and stomach can also be beneficial as they help balance the overactive muscles at the back of the neck and back.

Pain medications, including steroids and anti-inflammatory drugs, can be initially used to treat the sudden onset of severe pain associated with facet joint inflammation or the flare-up of chronic pain related to facet joint inflammation.

Spinal manipulation using muscle energy techniques or high-speed, low-power maneuvers can correct certain types of facet joint issues. These adjustments can help realign the facet joints which may help relieve pain.

Blocks, which are injections of anesthetic into or around the nerves, can be used to treat pain associated with facet joint inflammation. These blocks are guided using landmarks on the body, ultrasound, or live X-ray imaging. For pain that is resistant to previous treatments, a procedure called radiofrequency lesioning can be applied. This involves using a special current to numb the nerves transmitting pain signals from the facet joints.

Surgery is not the first option for treating facet joint inflammation. It is considered when the pain is unmanageable, causing loss of muscle control or bladder/bowel incontinence, or is accompanied by severely narrowed spinal canals or slipped disks.

When symptoms point to facet arthritis, doctors consider other conditions that could cause similar issues. These conditions include the following:

Herniated disc that’s squeezing the nerve roots
Pain caused by problems with a spinal disc, including its inner material bursting out
Radiculopathy, a nerve issue that leads to pain, weakness or numbness
Injuries to the muscles and ligaments in your trunk or lower back
Spondylolysis or spondylolisthesis, two different types of spine conditions
Piriformis syndrome, a type of buttock pain
Injury to the sacroiliac joint, which connects the spine to the hips
Compression of the superior cluneal nerve, a nerve in the lower back
Dysfunction in the thoracolumbar fascia, a layer of connective tissue in the lower back
Inflammatory arthritis of the spine, like rheumatoid arthritis or ankylosing spondylitis
Infection in the spine
Tumor in the spine

Each of these conditions has to be carefully considered and ruled out by the doctors to correctly diagnose facet arthritis.

In a controlled scientific study by Laxmaiah and his team, it was discovered that a certain type of treatment called ‘medial branch blocks’ that use local painkillers and Sarapin (a pain relieving medicine), and may also include steroids, can give significant relief from pain caused by facet arthritis. Facet arthritis is a condition where the small joints in the spine become inflamed.

The findings of the study showed that with one to three treatments, patients experienced total pain relief for one to three months. 82% of the patients had this relief for four to six months, while 21% recorded relief for seven to twelve months. However, only 10% continued to feel pain relief after 12 months.

The first step in treating facet arthritis involves teaching the patient about maintaining the correct posture in their everyday life, taking adequate rest, managing pain, and staying active. Physical therapy is typically the initial form of treatment. However, if the pain continues to persist even after therapy, a treatment called facet blocks can be performed. This helps in figuring out if the pain is indeed coming from the facet joint, a small joint located in between and behind the vertebrae of the spine. This will help the doctor to plan further treatments if needed.