Facet Syndrome and Facet Arthralgia

A very common reason for back pain involves the facets and what is termed “facet syndrome”. The facets (zygopophyseal joints) are the joints in the back part of the spine that lock into one another. They are true synovial joints with fluid and joint capsules. Facet syndrome is typically caused by compressive forces that jam the joints together.

Signs & Symptoms

Facet pain is often experienced as focal and localized sharp pain that can radiate outwards to about the size of a golf ball. In more severe cases, the pain can travel out further into the rib cage or down into the buttock. Facet joint dysfunction can be a result of arthritis and degeneration of the spine. This can often be seen on X-ray or MRI as a thickening of the facet called “facet hypertrophy” or “facet arthrosis”.

Causes of Facet Syndrome

Facet Syndrome is typically the result of malalignment of the joint which produces abnormal compressive forces in these joints. This can be a result of disc thinning which approximates the surface of the joints. It can also simply be a result of joint malposition directly causing the joints to “rub wrong”. The wear and tear on facet joints eventually produces arthritis or arthrosis of joints. Alternatively, entrapment of the meniscoid tissues within the facets can result in severe and sharp acute pain in the spine. Facet syndrome typically appears as a result of poor spinal mechanics which boils down to improper positioning and movement. This could be from lifting incorrectly, poor posture, or other bad habits. It could also be traumatic such as in a sports injury or auto accident.

Treatment for Facet Syndrome

Correcting abnormal spinal mechanics usually resolves facet joint dysfunction. The most effective treatment for facet dysfunction is manipulation of the spine with specific exercises. This will treat the root of the problem. It also may be necessary to modify habits at work or home to refrain from creating the dynamics responsible for condition. Therapies like E-stim and ultrasound may also be helpful to mitigate symptoms, but are not effective for correcting poor spinal mechanics. If the underlying reason for the facet irritation is loss of disc space, then modalities like traction and decompression are helpful.

Prognosis

If caught early, facet syndrome can be resolved within about a month or so. If the problem is left to persist then damage can lead to arthritis and degenerative changes. This makes the condition more difficult to treat and full resolution may not be possible. It is important to get in for treatment to stop the process from escalating in these situations. Periodic ongoing care may be necessary both in the clinic and at home.