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Download Facet Joint Dysfunction
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Facet Joint Dysfunction Normal Anatomy • Upper to lower – horizontal to vertical • Surrounded by fibrous capsule • Highly innervated • Source of nociceptive input • Source of sensory input from mechanoreceptors Pathophysiology • Joint surface and/or capsular tissue • Surrounding muscle spasm • Facet joint hypertrophy over time • Capsular thickening • Osteophyte formation Mechanism of Injury • Traumatic • Fracture (Emergency) • Dislocation (Emergency) • WAD • Degenerative • Spondylosis Mechanism of Injury • Traumatic • Fracture (Emergency) • Dislocation (Emergency) • WAD • Degenerative • Spondylosis Associated Pathologies • WAD • Cervical Spondylosis • Cervical Radiculopathy Subjective • Insidious/trauma • Ipsilateral neck pain • Referral pattern • Dull ache with sharp pain on movement • Morning stiffness • No neural generally Objective • ROM reduced and painful • Compression - Extension, contralateral rotation and ipsilateral side flexion • Capsular stress - Flexion, ipsilateral rotation and contralateral side flexion • Pain and stiffness segmental testing • Increased tone surrounding musculature Special Tests • PA Segmental Mobility • Extension Rotation Further Investigation • MRI • Diagnostic injections • CT Scan • Single-photon emission computed tomography (SPECT) Management • Nearly always conservative • Traumatic responds quickly • Settle inflammation, allow healing process • Degenerative slower • Change stress through area Conservative - Management • Pain Relief • NSAID’s, Ice or Heat, Massage • Restore ROM – Cervical AND Thoracic • Cervical Rotation, Extension, Thoracic Extension and Rotation • Soft Tissue, Joint Mobilisations, stretches • Restore Normal Muscle Activation • Deep cervical flexors, Deep cervical Extensors, Scapular upward rotators and posterior tilt • Restore Normal Dynamic Stability and Proprioception Plan B - Management • Injection • Intra-articular facet joint injections • Medial branch nerve blocks • Surgical • Radiofrequency neurotomy • considered if medial branch nerve block is successful
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