3 Common Facet Joint Diseases Include:
- Facet Joint Arthritis
- Facet Joint Dislocation
- Facet Joint Fracture
Facet Joint Arthritis:
One of the common facet joint disease is the inflammation of the facet joint causing severe pain, which is spread over middle of the back and paravertebral dermatome. The common cause of facet joint arthritis in elderly patient is Osteoarthritis and Rheumatoid Arthritis. The cause of facet joint arthritis in young and middle aged patient is traumatic injury of facet joint following sports or automobile injury. Facet joint arthritis is also observed in patients suffering with Psoriatic arthritis.
The pain radiates one to 3 segments above and below the level of abnormal or diseased facet joint. Pain is increased with flexion, extension and rotation movements of the vertebral column. Pain caused by facet joint disease in neck often radiates to shoulder joint.
Similarly facet joint pain caused by lumbar facet joint radiates to buttocks, back of the thigh and upper dermatome of knee joint.
Facet Joint Dislocation
Facet joint dislocation is a rare type of Facet Joint Disease and most often seen following neck injury. Cervical or neck facet joint subluxation (partial dislocation) is more common than mid or lower back facet joint dislocation. Cervical facet joint subluxation or dislocation is observed following direct impact during sport injury or automobile accident. Fall from height or work injury may cause lumbar facet joint dislocation. Blunt or penetrating injury often causes facet joint partial or complete dislocation in lower back and less often in mid back. Facet joint dislocation causes severe intractable pain with any back movements. Pain caused by facet joint dislocation is severe at rest and with activities. Patient with facet joint dislocation often prefers not to move neck or lower back. Patient prefers to keeps neck in fix position known as stiff neck or rigid back. Patient often is unable to lie dawn flat in bed and prefers to sit with neck braces. Paravertebral muscles are stiff and tender.
Facet Joint Fracture
Facet joint fracture is rare. Direct impact on facet joint during contact sport and automobile accident may cause isolated fracture of facet joint or dislocation and fracture of facet joint. Hairline and stable non-displaced fracture causes severe pain and paravertebral muscle spasm. The unstable displaced fracture causes severe pain at rest.
Comminuted (multiple fragments) fracture of articular process of facet joint causes irritation and compression of spinal nerve, which results in neurological symptoms like tingling, numbness and weakness. Pain is intense and often does not respond to conservative treatment. Character of pain is same as facet joint dislocation. Pain is associated with spasm of paravertebral muscles.
Symptoms and Signs of Facet Joint Diseases and Abnormalities
Chronic Pain- Facet joint pain is mostly localized over midback and paravertebral dermatome. Pain is most severe over the joint and referred to opposite side at dermatome of same level or spread one to several segments above and below the inflamed facet joint. Pain intensity is increased with movements of vertebral column. Facet joint pain in neck is referred to shoulder joint and lumbar facet joint pain is referred to back of the knee and thigh.
Back Stiffness- Pain is associated with stiff back. Stiff back is caused by increased pain with back movements and muscle spasm.
Muscle Spasm- Facet joint inflammation triggers paravertebral muscle contractions resulting in stiff back. Muscle contraction or spasm causes severe pain over the muscles.
Insomnia- Patients with facet joint disease often suffer with insomnia or are unable to sleep because of chronic severe pain. Mild to moderate pain increases in intensity when patient tries to lie down in bed.
Weight Loss- Weight loss is secondary to loss of appetite. Continuous on and often pain as well as restriction of activities causes loss of appetite and weight loss.
Lab Studies-
Abnormal Blood examination-
Blood examination in most cases is normal.
ESR (Erythrocyte Sedimentation Rate)- ESR is increased in patients suffering with Osteoarthritis. Osteoarthritis causes degenerative changes of facet joint.
X-Ray
X-ray image shows wide facet joint suggesting arthritis.
Magnetic resonance imaging (MRI)
MRI images of patient suffering with facet joint arthritis may show wide facet joint with swelling of synovial membrane. MRI images show the joint separation in patients suffering with facet joint dislocation. MRI image of patient suffering with facet joint fracture shows the hairline, unstable or comminuted fracture.
Ultrasound studies-
Ultrasound study is often normal or non-conclusive.
Differential Diagnosis
Blood Examination-
Facet joint arthritis is diagnosed when blood examination suggests patient is suffering with osteoarthritis and rheumatoid arthritis.
X-ray-
Facet joint arthritis is diagnosed when X-Ray pictures shows hypertrophy of facet joint. Facet joint dislocation and fracture is often difficult to appreciate with plain X-Ray.
MRI-
The MRI images helps to diagnose the inflammation, dislocation and fracture of facet joint. X-ray and MRI image shows the facet joint dislocation and fracture. Absence of radiological sign of fracture or dislocation of facet joint in patients suffering with facet joint pain suggests possible cause of back pain is facet joint arthritis.
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