ClinicalPatterns.com: Cervical facet arthropathy (non-systemic origin) WWWbfj

Symptom description

-Cervical region pain, ache, and stiffness -Referred pain/ache into head (OA to C2-C3), superior and medial scapular borders (C4-C5 to C6-C7) -Restricted cervical motion (unilateral or bilateral)

Behavior (Aggravating factors)

-Cervical AROM restriction with pain. Typically closing/compressing pattern (same side rotation/SB and extension restriction) or non-specific restriction -May have increased pain with or after sleeping, in AM, during or after prolonged sitting

Behavior (Easing factors)

-Stretching and cervical AROM typically in opening pattern -Posture correction (including chin tucks) -Rest (lying down) -May have relief with NSAIDs or steroids

Special questions & Red flags

-May overlap with other cervical DDD, rule out radiculopathy --Rule out visceral sources if risk factors identified

History

-Age: starting in 3rd decade and steady changes with increasing age May be traumatic onset i.e. s/p MVA with whiplash or earlier history of trauma -May have gradual onset without injury i.e. cumulative trauma from poor sitting habits of office worker -Idiopathic

Objective signs & Special tests

-May have postural faults -Cervical AROM: Increased pain and/or restriction with movement toward involved side or non-specific pattern. -(+) Cervical joint signs at involved level(s) (hypomobile and painful) -(+) tightness in surrounding cervical musculature esp. upper trap and scalenes -(+) Quadrant -May have (+) Spurlings and compression/distraction, but would not expect symptoms into shoulder or below

Treatment options

-Joint mobilization/manipulation at involved levels (unilateral > central PA’s gr. III to IV unless acute), include thoracic spine PRN -STM to taut and painful soft tissues -End range cervical PPiVMs and manual stretching -Cervical AROM and stretching -Progressive deep cervical flexor strengthening and general cervical and thoracic stabilization.