NECK PAIN coming from Joints

 Cervical facetogenic pain is a type of pain originating from the facet joints in the cervical spine (the neck). The facet joints are small, paired joints located at the back of each vertebra, and they help stabilize the spine while allowing for movement. When these joints become irritated, inflamed, or damaged, they can cause localized or referred pain, often described as cervical facetogenic pain.

Causes of Cervical Facetogenic Pain

• Degenerative changes: Wear and tear due to aging, also called osteoarthritis, can lead to cartilage breakdown and inflammation of the facet joints.
• Injury or trauma: Whiplash or other neck injuries can cause damage to the facet joints or their surrounding structures.
• Repetitive motion: Certain activities that involve repetitive neck movements can strain the facet joints, leading to pain.
• Postural strain: Poor posture, especially when sitting for prolonged periods or working at a computer, can increase stress on the cervical joints.

Symptoms

• Neck pain: The primary symptom, often described as a dull or aching pain, is usually located on one side of the neck.
• Radiating pain: The pain may radiate to the shoulders, upper back, or even the head (sometimes causing headaches).
• Limited neck mobility: Turning or tilting the head may be restricted or painful.
• Pain with certain movements: Pain tends to worsen with specific neck movements, like looking over the shoulder or tilting the head backward.
• Tenderness: Palpation of the affected facet joints may cause localized pain or discomfort.
• Stiffness in mornings or after a period of inactivity: Similar to any arthritis, you may wake up stiff in your neck, and it takes a while before you can move it.

Diagnosis

• Physical exam: Your doctor may examine the neck for tenderness and assess the range of motion.
• Imaging: X-rays, CT scans, or MRIs can help identify degenerative changes or other Treatment
• Diagnostic facet joint injections: In some cases, despite the above measures, a diagnosis cannot be made. In these situations, local anesthetics are injected into the surrounding nerves responsible for the sensation of pain in these small joints to confirm that the joint is the source of the pain. If the pain is temporarily relieved, it confirms the presence of facetogenic pain.

Conservative management

• • Rest, heat or cold therapy, and physical therapy to improve posture and strengthen neck muscles.
  • Medications like nonsteroidal anti-inflammatory drugs (NSAIDs) or muscle relaxants.

Interventional treatments:

• • Facet joint injections: Steroid injections can reduce inflammation and provide pain relief. Way better than steroid injection is the injection of PRP. See here for what PRP is.
  • Radiofrequency ablation (RFA): A procedure that uses electromagnetic waves to disrupt the nerves transmitting pain signals from the facet joint.

Surgical options (rare): In severe cases, if conservative treatments fail, surgical options like facet joint fusion or decompression may be considered.

How is the facet injection done?

These joints are the most superficial part of your spine. The spinal cord and big nerves are deeper structures. It means the risks of any significant nerve damage are very low. We use live X-ray to visualize the joints and the needle path as it approaches and enters these joints.