Rheumatology’s role: This is usually a mechanical or nerve-related spine condition treated by our pain and spine physicians. A rheumatologist may be involved when there are signs of inflammatory arthritis, such as morning stiffness, swelling in several joints or abnormal inflammation tests.
For full details on this condition, see our main page: Facet Syndrome.
Overview
The facet joints are small paired joints at the back of each spinal segment that guide movement. Like other joints, they can develop arthritis or become inflamed, which can cause neck or back pain.
Facet-related pain is often diagnosed with the help of a diagnostic injection. If a test injection provides short-term relief, radiofrequency ablation may be considered for longer-lasting relief.
Watch and learn
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Common symptoms
- Low back or neck pain on one or both sides
- Pain worse with twisting, leaning back or standing
- Stiffness, especially in the morning
- Pain that may refer into the buttock, thigh or shoulder blade
Causes and risk factors
- Age-related arthritis
- Disc degeneration that shifts load to the facets
- Prior injury such as whiplash
- Repetitive strain
How it is diagnosed
Diagnosis usually starts with a conversation about your symptoms and a physical exam. Depending on what we find, your clinician may order X-rays, an MRI or CT scan, or nerve tests. Imaging findings are interpreted together with your exam, because many people have changes on an MRI that do not cause pain. A medial branch block (a diagnostic injection) can help confirm whether the facet joints are the source of pain.
Treatment options
Self-care and lifestyle
Gentle stretching, core strengthening, heat and avoiding long periods of arching backward may help.
Physical therapy and medications
Physical therapy and anti-inflammatory medicines, if safe for you.
Injections and nerve blocks
Medial branch blocks or facet joint injections help confirm that the facet joints are the source and may relieve pain.
Minimally invasive procedures
Radiofrequency ablation of the medial branch nerves may provide longer-lasting relief for confirmed facet pain.
Surgical evaluation
Surgery is uncommon for facet pain alone; it is considered when there is instability or nerve compression.
Frequently asked questions
How do you know the pain is from the facet joints?
There is no single test. Exam findings and imaging help, and a diagnostic block that temporarily numbs the nerves to the joint can help confirm the source.
What is radiofrequency ablation?
It uses heat to interrupt the small nerves that carry pain signals from the facet joints. Relief can last months, and the nerves can regrow over time.
Is facet syndrome serious?
It is common and usually managed without surgery.
This page is general patient education and does not replace advice from your own clinician. Individual results vary.