5. Facet Syndrome Flashcards
What is facet syndrome?
Painful disorder originating from facet joints, joint capsules and adjacent soft tissues and can include structural changes such as osteoarthritis, capsular tears, synovial cysts and articular cartilage injury
Can facet syndrome lead to nerve compression?
Yes. If there is a synovial cyst in the facet joint, it can compress the nerve root. This is usually diagnosed as a space occupying lesion or spinal stenosis instead of facet syndrome
What is the prevalence of facet syndrome in the general population? Prevalence in older population?
General = 15% Older = 40%
Describe the back pain associated with facet syndrome
Deep and achy
Paraspinal (not midline)
Stiffness and pain may be worse in the am
Aggravated by hyperextension or inactivity
Walking is least painful activity (unless it is downhill due to extension)
Sitting is least painful position due to flexion
What are the common mechanisms of injury for facet syndrome?
- chronic postural or repetitive loads
- trauma with strong eccentric or concentric contraction of low back postural muscles
- sports that require repetitive extension or rotation
- insidiously due to degenerative changes of older patients
Describe the pain referral from facet syndrome (5 things)
- non-dermatomal with overlapping territories due to facets being innervated from above and below
- can refer to front and back of leg
- can refer as far as foot
- may not be contiguous
- referred pain territories from facets and discs overlap and therefore cannot be distinguished
What are some let exam findings with facet syndrome?
- pain aggravated by extension
- positive Kemp’s test
- tenderness paraspinally with static palpation
- restricted and painful joints with motion palpation
How is Kemp’s test diagnostically useful for facet syndrome?
Kemp’s is usually positive with facet syndrome but less commonly can be positive with deranged disc and sprains as well so negative Kemps is better evidence against facet syndrome
In other words, Kemps test is a pertinent negative that would be evidence against facet syndrome
What physical exam findings should be negative for the diagnosis of facet syndrome?
- pain centralizing shouldn’t occur
- Valsalva should be negative
- flexion loading tests shouldn’t be provocative
- no nerve root involvement (SLR and SMRs should be negative)
What is the best evidence against facet syndrome?
- pain centralization
- negative Kemps test
- lack of improvement with recumbency
These would indicated a diagnosis other than facet syndrome
What is the difference between the diagnosis of facet syndrome and joint/segmental dysfunction?
Only palpatory findings would be joint dysfunction.
If there are other findings then it would be facet syndrome
What ancillary studies are indicated in the diagnosis of facet syndrome?
None because even if X-rays show degeneration around the facet, there has been little correlation with the syndrome. If the degenerative changes are causing radicular symptoms, then the diagnosis is no longer facet syndrome and X-ray followed by MRI may be needed to see the SOL or IVF stenosis that is causing the compression
What treatment options are available for patients who have failed conservative treatment?
Therapeutic facet blocks (can also be used diagnostically to confirm facets as pain generator)
What three things are injection into the joint space during a facet block?
- contrast dye
- anesthetic
- corticosteroid
How is a facet syndrome diagnosis established with a facet block?
If there is pain relief that corresponds to the duration of the injected anesthetic. Double block (two different anesthetic durations used) is more accurate
