Lumbar Facet Syndrome
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Search Strategy[edit | edit source]
To gather information on this subject I consulted Google using following search items: “common lower back pain”. Here I found the term: “Lumbar facet syndrome”. Then I searched in the library of the Vrije Universiteit Brussel for books. Further I searched for scientific articles on PubMed and Web of knowledge using following key words: “Lumbar facet syndrome” and “zygopophysial joint pain”.
Definition/Description[edit | edit source]
Lumbar facet syndrome means: A dysfunction at the level of the posterior facet joints of the spine. These joints together with the disc form the intervertebral joint. Changes at the level of the posterior facet joints can influence the disc and vice versa.
The term ‘dysfunction’ implies that at a certain level (mostly L4-L5 or L5-S1) these 3 components do not function normally.
The lumbar facet syndrome is a painful irritation of the posterior part of the lumbar spine. Swelling from the surrounding structures, can cause pain due to an irritation of the nerve roots.
Little capsular tears can originate at the level of the posterior facet joints due to a trauma. This can lead to a subluxation of the joint. The synovia that surrounds the joint is damaged and leads to a synovitis. Secondly a hypertonic contraction of the surrounding muscles present itself. This is a protection mechanism that increases the pain. These changes lead to a fibrosis and osteophyte formation.
The most common cause is repetitive micro trauma and as positive result of this chronic degeneration. In daily living this may occur with repetitive extension of the back. So mostly all movements with the arms above the head.
These recurring injuries can happen in sports were it is necessary to make repetitive powerful hyperextensions of the lumbar spine.
An irritation can also occur when the intervertebral disc is damaged and the biomechanics of the joint have changed. In this case the facet joints are exposed to a higher loading.
Clinically Relevant Anatomy[edit | edit source]
For relevant anatomy I refer to Cohen S. P. et Al. [4] and Facet joint syndrome clinically relevant Anatomy
Epidemiology /Etiology[edit | edit source]
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Characteristics/Clinical Presentation[edit | edit source]
The lumbar facet syndrome is characterized by: (signs and symptoms)
- sensibility/pain local and ipsilateral [2],
- pain in hyperextension
- pain in hip, bottom and back when lifting a extended leg
- referred pain not further than the knee[2,3]
- local stiffness
Pain: mild – severe, different between patients and within patient.
Differential Diagnosis[edit | edit source]
Increase pain.[2]:
- Extension
- Rotation
- Prolonged standing
- Sudden movements
- After rest
- Lateral flexion towards affected side
- Returning from flexed position
- Movements in general
Decrease pain[2]:
- Walking
- Lying with knees bent
- Medication
- Supported flexion, sitting, standing with weight on hands and elbows
- Rest
- Lateral bending towards healthy side
- Varying activity
Signs and symptoms of discogenetic problems [2]
- antalgia/lateral shift,
- limping,
- parasthesia,
- Radicular leg pain.
Increasing pain:
Sitting, flexion, using a clutch (in a vehicle), coughing and/or sneezing, and walking for a long time
Diagnostic Procedures[edit | edit source]
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Outcome Measures[edit | edit source]
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Examination[edit | edit source]
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Medical Management
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Physical Therapy Management
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Key Research[edit | edit source]
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Resources
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Clinical Bottom Line[edit | edit source]
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Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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