Why neck and shoulder girdle pain can come from the cervical facet joints and what we can do about it.

-

The cervical facet joints are moving parts situated in the back of the cervical spine. Together with the cervical discs, the facet joints help us support and move our spine, and protect the cervical nerve roots and spinal cord.” ]
Just like any other load-bearing joints, the facet joint can sustain wear and tear, known as degeneration, osteoarthritis, or arthritis for short. Sometimes, but not all the time, joint arthritis can be painful. This is manifested as neck pain, but also shoulder girdle and upper arm pain, pain in-between and over the shoulder blades, and, very importantly, headaches.
There is an important caveat at this point: do not be fooled by the appearance of these joints on X-rays, MRIs, etc. Normal-looking joints can be painful and very degenerated joints can be completely painless. This is why we can only find out whether these joints are painful or not by means of spinal injections.
Pain from the facet joints is transmitted to the spinal cord and ultimately to the brain through small nerve twigs called medial branches, which sit in bony grooves of the cervical spine.
For cervical/neck pain that has not improved with rest, time, physical therapy, chiropractic therapy, anti-inflammatory medication, we can find out whether this pain comes from the cervical facet joints by performing simple cervical injections called medial branch blocks. These are X-ray-guided injections of local anesthetics over the bony grooves I mentioned earlier aimed at numbing the medial branches, and therefore cutting off the pain transmission from the facet joints to the spinal cord and brain. The principle is simple: if the pain goes away while the medial branches are numb (generally several hours), then it is highly likely that the facet joints are causing the pain.
There is a second important caveat here: the medial branch blocks need to be performed twice, with different local anesthetics. Only if the pain goes away both times we can establish a correct diagnosis of facet joint pain.
Once we found the off-switch for pain to be in the facet joints, then we can proceed with treatment.
Although injections of corticosteroids inside the facet joints is not a proven treatment, sometimes this intervention offers several months of pain relief. In my experience, only 20-30% of patients benefit from this, with pain relief of 3 months or longer.
The proven treatment for facet joint pain is called radiofrequency treatment of the medial branches. This is sometimes called neurotomy or rhizotomy, meaning destruction of the medial branches.
The radiofrequency neurotomy employs placement of needles close to the medial branches, in the bony grooves mentioned above, and heating the needle tips to destroy the medial branch. This is of course done with local anesthetics, with or without sedation.
After radiofrequency neurotomy, pain relief may be delayed up to 4 weeks, and may last anywhere from 6-18 months. Pain may return after this period of time because of regeneration of the medial branches. If or when pain returns, the radiofrequency treatment may be repeated.
Some of the common questions from patients regarding radiofrequency treatment are:
If you destroy my nerves, will I lose sensation to other spinal structures? The answer is no. The medial branches are very specialized small nerves that only transmit pain from the facet joints. Sensation from the other surrounding spinal structures is not affected.
Patients also frequently ask: If I don’t feel pain, will I hurt my neck more? Again, the answer is no. Pain from other cervical structures will continue to be felt, and in case of a more serious bone contusion, deeper pain receptors will be stimulated with pain signals felt by the injured person.

Comments

Post a Comment

Popular posts from this blog

Alpha-2-macroglobulin and a possible alternative to medications or surgery in the treatment of osteoarthritis

-
Image
Wouldn’t it be miraculous if within your own blood stream you were carrying around a biologic treatment for your arthritic knee? Well, it’s true! Your body creates a very large protein in your liver which is carried via your blood stream to your various organs and has several important roles to keep you healthy. The protein is called “alpha-2-macroglobulin” (A2M) and is among the largest and heaviest proteins that your body makes. It is a naturally occurring plasma glycoprotein whose principal activity is to counteract the protein/enzymes called “proteases” that breakdown various chemicals and molecules no longer needed in your body in a well-balanced chain of events that keeps you healthy. In a tremendous breakthrough, scientists at the Cytonics, Corp. have discovered that this very large protein can capture and neutralize the chemicals created in an arthritic joint that cause the destruction of the articular cartilage. By reducing these destructive substances, it effectively ha...
Read more

Treatment for back pain and leg pain

-
Image
Back pain is one of the most common symptoms seen in our Austin Westlake Clinic. It happens to many people, and in most cases, the low back pain symptoms are similar for eveybody. They could be ongoing, worsening pain down the leg into the foot, one sided pain on the buttock or leg, severe burning and tingling, weakness, numbness or difficulty moving the leg or foot. Whether it’s related to an accident, poor posture, injury or degeneration,  leg pain or back pain is the most common symptom seen in our Austin Westlake clinic. We aim to diagnose your pain based on individual circumstances and then treat your symptoms with modern, cutting-edge, non-surgical procedures. If you are experiencing shooting pain down the leg, herniated discs may be the problem. Arthritic bones in the facet joints can also irritate the lumbar nerves. Treatments for chronic pain in the lower back and loss of sensation or weakness in the leg include more conservative options such as physical therapy, ...
Read more

Tommy John surgery for baseball elbow injuries – is it always necessary?

-
Image
For all the baseball fans, or players, out there, I hope everybody enjoyed the World Series. Today, I would like to talk about one of the most common baseball injuries. This is an elbow injury, called ulnar collateral ligament tear. These days, as young players tend to specialize earlier and earlier and only play one sport, overuse injuries seem to be more and more common and seem to happen earlier in life. Ulnar collateral ligament injury is the result of repetitive use of the elbow during baseball throwing motion. This injury has been historically treated with ulnar collateral ligament reconstruction. During this surgery, the ligament in the medial (inside) elbow is replaced with a tendon from somewhere else in the body, be it from the forearm, hamstring, or foot. This surgery was first performed in 1974 by Dr. Frank Jobe, on Tommy John, a pitcher who ironically started his career in 1963 with the Cleveland Indians (for all of you Cleveland World Series fans). While this su...
Read more