Facet Syndrome

Question 1

What are exam findings for facet syndrome?

Answer 1

• tenderness over facet
• palpable local spasm
• joint restriction (AP glide)
• extension may reproduce/aggravate local pain (active extension, neutral and max C/S compression, quadrant position, cervical kemps)
• At least one would make you think facet but more than one would be nice
• you want something from the last bullet

Question 2

Who would respond to a facet block? What is the +LR

Answer 2

A combination of 
- pain (at least 3/10) with ER test 
- pain (at least 3/10) with palpation over facet
- restricted in P-A glide 
\+ LR 4.95

Question 3

What would indicate patient would not respond well to facet blocks?

Answer 3

• no Palpatory tenderness over facets (-LR 0.8)

- no Palpatory P-A glide restriction (-LR 0.11)

Question 4

What are pertinent negatives against facet?

Answer 4

• rarely cause radicular syndromes
• rarely neurological deficits
• distal arm symptoms rarely reproduced by cervical orthopedic tests or tension tests

Question 5

What is the treatment for facet syndrome?

Answer 5

• CMT = Manipulate/mobilize
• STM = stretch/relax tight muscles
• Activity/behavior= avoid extension and rotation of neck
• Exercise = isometric neck flexor exercises