Cervical facet arthropathy is a specific source of chronic neck discomfort that arises from degeneration in the small joints of the neck. In the cervical spine, it describes the progressive wearing down of the structures that enable head movement and stability. Neck pain significantly impacts daily life, and pinpointing the exact cause is the first step toward effective management. Understanding this condition allows for a targeted approach to diagnosis and treatment.
Anatomy and Degenerative Process
The cervical spine, or neck, consists of seven vertebrae, labeled C1 through C7. At the back of each vertebral segment are two small joints known as the facet joints, or zygapophyseal joints. These paired, synovial joints are lined with smooth cartilage and surrounded by a fibrous capsule containing lubricating synovial fluid. They allow the neck to bend, rotate, and extend while preventing excessive motion.
Cervical facet arthropathy begins with the gradual deterioration of the protective articular cartilage within these joints. As the cartilage wears thin due to cumulative stress or injury, the underlying bone surfaces begin to rub against each other. This friction generates inflammation, which leads to pain and the subsequent formation of osteophytes, or bone spurs, that further restrict movement.
This degenerative breakdown is most frequently a result of age-related wear and tear, similar to osteoarthritis in other body joints. Previous neck trauma, such as a whiplash injury from a car accident, can accelerate the process by causing microtears in the joint ligaments and capsule. Poor posture, often associated with prolonged use of electronic devices, also contributes by placing chronic, excessive strain on the facet joints.
Recognizing the Pain Signals
Pain originating from the cervical facet joints is a dull ache or stiffness localized in the back of the neck. The discomfort intensifies with specific movements, particularly when extending the neck backward or rotating the head fully to one side. This mechanical pattern of pain aggravation helps distinguish it from other sources of neck pain.
Cervical facet arthropathy often involves referred pain, where discomfort is felt in an area distant from the neck itself. The C2-C3 facet joint is a frequent source of chronic headaches, known as cervicogenic headache, due to its association with the third occipital nerve. These headaches are often felt at the base of the skull, over the temples, or behind the eyes.
Irritation at lower levels, such as C5-C6, often causes pain to radiate down into the shoulder, shoulder blade region, or upper arm. This discomfort is a diffuse, aching sensation and usually does not extend past the elbow, differentiating it from true nerve root compression. Stiffness, especially upon waking or after long periods of inactivity, is also common and limits the neck’s range of motion.
Confirming the Diagnosis
The diagnostic process begins with a physical examination, where a medical professional assesses the patient’s range of motion and checks for tenderness directly over the cervical spine. Tenderness over specific facet joints suggests they may be the source of the pain. However, these clinical findings are non-specific and require further investigation.
Imaging studies are used to visualize degenerative changes and exclude other conditions. Standard X-rays can reveal reduced joint space and bone spurs (osteophytes), while a Computed Tomography (CT) scan provides superior detail of the bony anatomy. Magnetic Resonance Imaging (MRI) is used to rule out soft tissue issues, such as a herniated disc or spinal cord compression.
The definitive method for confirming cervical facet arthropathy as the pain generator is a diagnostic injection procedure, known as a medial branch block (MBB). This minimally invasive test involves injecting a local anesthetic near the medial branch nerves that transmit pain signals from the facet joints. Pain relief of 50 percent or more immediately following the injection strongly indicates the targeted joint is the source of the symptoms. Medical guidelines recommend performing two separate, successful diagnostic blocks on two different occasions to confirm the underlying cause.
Treatment and Long-Term Management
The initial approach to managing cervical facet arthropathy focuses on conservative, non-invasive methods. Physical therapy is a primary intervention that helps strengthen the supportive neck musculature, improve posture, and restore range of motion. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) and applying heat or ice provide temporary relief from acute pain flares and inflammation.
When conservative measures are insufficient, injection-based therapies are used. A corticosteroid injection delivered directly into the inflamed facet joint provides temporary, yet significant, pain relief by reducing local inflammation. Since the relief from a steroid injection is not permanent, it is often used as a bridge to allow the patient to participate more effectively in physical therapy.
For chronic pain confirmed by diagnostic blocks, Radiofrequency Ablation (RFA), also known as radiofrequency neurotomy, is a more enduring treatment option. This procedure uses an electrical current to heat a small area of the medial branch nerve, halting its ability to transmit pain signals from the arthritic facet joint to the brain. RFA provides sustained pain relief, typically lasting between six months and over a year, and can be safely repeated if symptoms return. Surgical procedures, such as cervical fusion, are only considered in severe cases involving significant spinal instability or neurological deficits.