FJP Definition

• Role of the Facet Joint:

  • Load Transmission
  • Stabilize vertebra in flexion/extension
  • Resist axial rotation and anterior translation
• Facet Joint Pain:

  1. Due to sprain, or gradual degeneration or both
  2. Produces both local (could be somatic) and radiating (due to noxious stimuli affecting nerve roots exiting the foramina) pain
  3. Inflammation causes the joint to swell, leading to stretching of the capsule and subsequent pain generation
  4. can also irritate the nearby spinal nerves
  5. resulting in spasm of the deep postural paraspinal muscles (e.g. Multifidus)
• Facet Joint Pain:

  • Predisposing factors for lumbar facet joint pain are spondylolisthesis, spondylolysis, degenerative disc disease and older age
  • 2 types:
  • Intra-articular: located within the articulation, aggravated by compression of articular surfaces or degenerative change
  • Peri-articular: located outside of the joint space, aggravated by stretching of an irritable joint capsule

  
• Clinical Presentation of Facet Joint Pain - History and MOI:

  • Often involves combined movement at the lumbar spine (example flexion and rotation)
  • Acute sprain/pain – specific incident
  • Repetitive Overload – insidious onset
• Clinical Presentation of Facet Joint Pain - Subjective Features:

  • lower back pain (unilateral or bilateral)
  • Can radiate down lower limb
  • Unlikely to present with radiculopathy (motor weakness or paraesthesia and/or anaesthesia)
• Clinical Presentation of Facet Joint Pain - Subjective Features:

  • lower back pain (unilateral or bilateral)
  • Can radiate down lower limb
  • Unlikely to present with radiculopathy (motor weakness or paraesthesia and/or anaesthesia)
  • Aggs:
  • If degenerative, extension may be painful/ stiff
  • If sprain to the capsule, flexion/stretching may be painful
  • Often stiff or painful in morning/ following periods of rest or after increased activity/ loading e.g. prolonged standing, walking
• Clinical Presentation of Facet Joint Pain - Objective Features:

  • Unilateral or bilateral pain / tenderness
  • Negative neuro integrity (as we dont expect motor or sensory changes) and no progressive neuro
  • Movements that ‘open’ joint/ stretch capsule may aggravate pain
  • Flexion, rotation and side bending contralateral side
  • Movements that ‘close’/ compress joint may aggravate pain
  • Extension, rotation and side bending ipsilateral side
• Clinical Presentation of Facet Joint Pain - Key impairments:

  • Pain and consequently decrease in ROM hence decreased motor power
• Clinical Presentation of Facet Joint Pain - Does this patient warrant a scan?

  • generally there should be negative results from a neuro integrity test, so there should be no progressive neuro
  • but if we suspect any sinister disease and theres lots of yeses to some of the spinal cord special questions or if we suspect serious spinal pathology or progressive neuro then we must send this patient for a scan