The cervical facet (zygapophyseal) joints are paired synovial joints between the articular processes of adjacent cervical vertebrae from C2-C3 down to C7-T1. Their facets are angled at about 45 degrees, which allows the neck a wide range of flexion, extension, lateral flexion and rotation while guiding and limiting forward slippage of one vertebra on the next.
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The cervical facet joints are a common source of chronic neck pain, especially after whiplash, and each level refers pain to a fairly predictable area of the neck, shoulder or head (C2-C3 often causes headache). Diagnosis is confirmed with medial branch blocks, and radiofrequency ablation of the medial branches can give lasting relief. Facet arthritis with osteophytes can narrow the intervertebral foramen and compress the exiting nerve root. In flexion-rotation trauma the facets can sublux or dislocate, producing unilateral or bilateral locked facets.
Degenerative or post-traumatic facet pain producing neck stiffness and referred pain to the shoulder or head, confirmed by medial branch blocks and treated with physiotherapy, injection or radiofrequency ablation.
Capsular strain or small articular injuries of the facet joints from rapid acceleration-deceleration, a leading cause of persistent neck pain after road traffic collisions.
Flexion-rotation trauma that drives the inferior facet over the superior facet of the vertebra below, unilateral or bilateral, often with spinal cord or nerve root injury and needing urgent reduction and stabilisation.
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