Facet joint pain

introduction

The Facet joints will too Vertebral arch joints called. They form an articulated connection between neighboring ones whirl. Together with the Band washers (Intervertebral discs) and the spinal ligaments, which also extend over the entire Spine extend, the facet joints form an important unit for the stability and flexible connection of the spine. Each vertebra is equipped with two facet joints that connect an articular process from the upper and lower vertebra as a joint on the vertebral arch. The facet joints allow the spine to move parallel to its articular surfaces, it is about Sliding joints.

These little ones Joints are very sensitive to pain as they are each affected by one Joint capsule which contain a multitude of pain receptors. Various causes such as Signs of wear and tear in the facet joints can lead to severe pain. One also speaks of Vertebral joint arthrosis, there is pain, restricted mobility, loss of function, significant restrictions in everyday life and, as a long-term consequence, sometimes also Ossification of the facet joints. This complex of different symptoms, which are triggered by signs of wear and tear on the small facet joints of the spine, is summarized as the so-called facet syndrome.

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The spine is difficult to treat. On the one hand it is exposed to high mechanical loads, on the other hand it has great mobility.

The treatment of the spine (e.g. herniated disc, facet syndrome, foramen stenosis, etc.) therefore requires a lot of experience.
I focus on a wide variety of diseases of the spine.
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Symptoms

The pain caused by the facet joints is typically called deep back pain felt. Sometimes there is a belt-shaped radiation of the pain from the vertebral joints. Different degrees of pain are described. They can be from the lumbar spineLumbar spine until the Glutes or the back of the Thigh muscles pass.

In some cases the Cervical spine affected by facet syndrome. Here there is often a radiation of pain over the Neck muscles in the Shoulder- and Upper arm areas. It can also become very uncomfortable and recurrently strong a headache come when the pain spreads over the back of the head.

In addition to the pain, depending on the severity of the damage to the facet joints, sensory disorders in the arms and legs can also occur. Tingling sensations or numbness indicate progressive damage to the areas near the spine annoy and may represent an emergency that should be dealt with as soon as possible.

The back muscles react as another common symptom of facet syndromeBack muscles usually extremely sensitive to touch along the spine.

Furthermore, there is often an increase in pain when turning movements are performed. For example, a movement similar to a tee shot when golfing leads to an increase in pain, since the facet joints are moved and further irritated with such rotational movements. Leaning forward or backward can also be so painful that you can often only take Medication are possible without pain.

Typically, the pain in the area of ​​the facet joints is load-dependent. They occur in the morning immediately after getting up, as the spine now has to bear the body weight again after the night's rest and new pressure is created on the facet joints.

causes

Similar to other joints of the body (e.g. in the knee) age-related signs of wear can also occur in the facet joints. This process is also called Spinal osteoarthritis denotes and expresses itself by the fact that the protective Articular cartilage wears out and the bone start rubbing against each other, which can lead to very painful conditions. The facet joints usually only have to bear a low pressure load, but incorrect posture and incorrect loading can lead to a significant increase in pressure and thus also to joint wear.

Very often it comes from diseases of the Intervertebral disc to an enormous increase in the pressure load on the facet joints. If the disc space is compressed, for example by a disc prolapseDue to wear of the intervertebral discs or surgical removal of the intervertebral discs, a difference in height of just a few millimeters leads to a strong increase in pressure in the area of ​​the facet joints. This process is also carried out by Obesity, osteoporosis (Bone loss) and inadequate support and back muscles worsen.

Particularly severe pain can be caused by Cysts or so-called Ganglia (Connective tissue overgrowth near the facet joints. In women in particular, such ganglia occur in highly stressed areas such as the Lumbar spine (lumbar facet syndrome) on. A narrowing of the bony canal through which the Spinal cord runs, a so-called Spinal stenosis, is one of the causes of facet syndrome. This can lead to painful entrapment of nerves and direct joint damage.

Furthermore, it can go through Vertebral blockages or instabilities of the spine lead to pain in the area of ​​the facet joints. Reflex muscle tension, which is often triggered by excessive strain or improper strain, is one of the possible causes of pain.

The rarer causes of facet syndrome include rare ones Tumors or Metastases as well as since birth existing malformations of the spine. Certain rheumatic diseases (rheumatism) again ankylosing spondylitis can be the cause of pain in the area of ​​the facet joints.

diagnosis

Back pain are a very common symptom that can have a variety of causes and that are usually treated by a family doctor or orthopedic surgeon. In most cases, relatively harmless causes (e.g. age-related signs of wear and tear) are responsible for the pain, which is why one usually starts with one physical examination in connection with the medical history (anamnese) is sufficient to make a diagnosis of facet joint syndrome. The mobility and sensitivity of the spine and back muscles are tested. The exact localization and the intensification of the pain with certain movements are very important in making a diagnosis. Standardized pain questionnaires can be used to precisely record and assess pain.

In some cases it can be useful to have a imaging diagnostics perform. A X-rays, a CT or a MRI (Nuclear spin) can be made to detect bony changes in the facet joints or other damage to the spine such as a herniated disc. However, wear and tear on the joints, which can be shown in the pictures, does not necessarily have to be the cause of the complaints. This is due to the fact that wear and tear is an age-related phenomenon and signs of wear can be seen in the imaging even in people who are actually pain-free. In order to prove that the pain is actually being caused by the facet joints, an X-ray can be used under certain circumstances Painkiller injected into the small joints. A facet joint arthrosis is considered proven if the person concerned is pain-free for a while after the injection.

The reliable exclusion of other diagnoses plays a decisive role in the diagnosis of back pain. In the case of pain in the area of ​​the facet joints, this includes herniated discs, slipping of the vertebrae (Spondylolisthesis) or Spinal stenosis. Also a Vertebral fracture (fracture) can be present, because with severe osteoporosis (bone loss) a bone or a vertebra can break without further external influence. In addition, irritation in the area of ​​the Sacrum and iliac joint (Sacroiliac joint) or one Hip arthrosis also lead to pain in the area of ​​the facet joints and must be excluded diagnostically.

therapy

Facet joint pain can have a variety of causes. Depending on the trigger of the disease, operative and non-operative (conservative) Therapy options under consideration. As a rule, targeted training and strengthening are available Core muscles such as Relaxation exercises in the foreground. It can be useful, under the guidance of a Physiotherapists to learn the correct execution and the correct amount of strengthening exercises. Regular physical exercise in the form of jogging, to go biking or swim are also recommended to prevent pain in any case.

Also heat applications through Infrared light or hot water bottles can provide relief, as the warmed areas are better supplied with blood and healing processes can take place more quickly. A similar effect can be achieved by relaxing Massages can be achieved, as the pain often causes a relieving posture that leads to additional tension in the muscles, which can be released by massage. Alternative healing methods such as the Magnetic therapy or acupuncture are used. Pain medication can support the treatment; medications such as Paracetamol or Ibuprofen for use. For severe pain, stronger pain relievers can also be used Opioids be applied.

Short-term and temporary freedom from pain can be achieved through a Injection therapy can be achieved. This will usually be a local anesthetic and possibly a low dose of the anti-inflammatory agent cortisone injected into the facet joints. This measure can be useful, for example, if the pain is so severe that the person concerned cannot move sufficiently. There Move But one of the most important therapeutic measures is, in this way, a short-term freedom from pain can be achieved, so that suitable training can be started.

Only when the aforementioned measures have not led to an improvement in the pain and it has been proven that the pain is actually caused by the small facet joints are more invasive procedures used. One method is the so-called Facet joint thermocoagulation In the course of a short, minimally invasive procedure, the small pain-conducting nerves are obliterated by tiny punctures with a needle. Thus, the cause of the pain (i.e. the signs of wear and tear) is not eliminated, but rather the perception of the pain is prevented by the interruption of the transmission. Another therapy method comes with so-called Spreaders in question. A placeholder or spreader is introduced and stretched in a minimally invasive manner between the vertebrae. This reduces the pressure on the facet joints and usually also reduces the pain in connection with it.

prophylaxis

Pain in the facet joints or anywhere else in the musculoskeletal system is often very tricky. Because of the pain, those affected are quickly tempted to move less. But here it comes to one quickly Vicious circle, because the less movement, the greater the pain. Nowadays we know that movement is especially important for Back pain the best therapy is. Rest and bed rest make the situation worse and make it difficult to return to normal everyday life. The therapy of pain in the area of ​​the facet joints and also the prevention of pain consists in targeted training to restore mobility and resilience.

Strengthening players play here Build-up exercises for the Move- and Chest muscles However, general and regular physical activity is just as important. Of course, very painful movements should be avoided, as they are a warning sign from the body as to when the strain is too strong. However, that does not mean that a long walk, a bike ride or a few laps in the swimming pool are still not possible. This strengthens the muscles and improves mobility. It may be helpful to take a pain medication before moving, such as Ibuprofen because movement is very important but should not be done with pain.