1. Facet Joint Dysfunction

2. Normal Anatomy Upper to lower – horizontal to vertical
Surrounded by fibrous capsule
Highly innervated
Source of nociceptive input
Source of sensory input from mechanoreceptors

3. Pathophysiology Joint surface and/or capsular tissue
Surrounding muscle spasm
Facet joint hypertrophy over time
Capsular thickening
Osteophyte formation

4. Mechanism of Injury Traumatic Degenerative Fracture (Emergency)
Dislocation (Emergency)
WAD
Degenerative
Spondylosis

5. Mechanism of Injury Traumatic Degenerative Fracture (Emergency)
Dislocation (Emergency)
WAD
Degenerative
Spondylosis

6. Associated Pathologies
WAD
Cervical Spondylosis
Cervical Radiculopathy

7. Subjective Insidious/trauma Ipsilateral neck pain Referral pattern
Dull ache with sharp pain on movement
Morning stiffness
No neural generally

8. Objective ROM reduced and painful Pain and stiffness segmental testing
Compression - Extension, contralateral rotation and ipsilateral side flexion
Capsular stress - Flexion, ipsilateral rotation and contralateral side flexion
Pain and stiffness segmental testing
Increased tone surrounding musculature

9. Special Tests
PA Segmental Mobility
Extension Rotation

10. Further Investigation
MRI
Diagnostic injections
CT Scan
Single-photon emission computed tomography (SPECT)

11. Management Nearly always conservative Traumatic responds quickly
Settle inflammation, allow healing process
Degenerative slower
Change stress through area

12. Conservative - Management
Pain Relief
NSAID’s, Ice or Heat, Massage
Restore ROM – Cervical AND Thoracic
Cervical Rotation, Extension, Thoracic Extension and Rotation
Soft Tissue, Joint Mobilisations, stretches
Restore Normal Muscle Activation
Deep cervical flexors, Deep cervical Extensors, Scapular upward rotators and posterior tilt
Restore Normal Dynamic Stability and Proprioception

13. Plan B - Management Injection Surgical
Intra-articular facet joint injections
Medial branch nerve blocks
Surgical
Radiofrequency neurotomy
considered if medial branch nerve block is successful