Thoracic Facet Joint Pain

Thoracic Facet Arthropathy / Thoracic Facet Syndrome

What is Thoracic Facet Joint Pain?

Thoracic facet joint pain, also known as thoracic facet arthropathy or thoracic facet syndrome, refers to the discomfort and inflammation experienced in the facet joints of the thoracic spine. Medical professionals often characterise this condition as facet joint disease or sprain. The facet joints are synovial joints situated between the vertebrae of the spine. Each spinal motion segment contains a pair of facet joints comprising a left and a right joint. The cervical facet joints (neck), thoracic facet joints (mid-back), and lumbar facet joints (low back) collectively constitute the facet joints throughout the various sections of the spine. Functionally, these facet joints guide and restrict the movement of their corresponding spinal motion segments. Consequently, facet joint pain frequently accounts for thoracic spine pain, making it one of the most prevalent causes of such discomfort.

What Causes Thoracic Facet Joint Pain?

Facet joint motion can be disturbed by injury. Joint action can stiffen – which is known as hypomobility. Alternatively, joint movement can become excessive – known as hypermobility.

What Causes Thoracic Facet Joint Hypomobility?

Thoracic facet joint hypomobility can occur due to various factors, including a locked facet joint, facet joint arthritis, degenerative facet joint osteophytes (bone spurs), scarring, thickening, or shortening of the joint capsule, or protective muscle spasm. A facet joint may become stiff through gradual degeneration. Maintaining local muscle strength becomes crucial for stabilising and controlling the facet joints.

On the other hand, trauma or connective tissue disorders primarily cause thoracic facet joint hypermobility. This condition can result from fractures, dislocations, overstretched ligaments, or diseases that lead to joint destruction, such as Rheumatoid Arthritis.

What Causes Thoracic Facet Joint Hypermobility?

Trauma usually causes hypermobility. Examples include:

• Fracture,
• Dislocation,
• Overstretched ligaments, or
• Any destructive joint disease, e.g. Rheumatoid Arthritis.

What Causes a Locked Thoracic Facet Joint?

Simple movements such as a mild twist, awkward movement, or just doing something your body didn’t expect (such as tripping) can lock a facet joint. In most cases, this is due to your facet joints’ motion exceeding your muscle control.

Suppose you have previously suffered an injury or have local muscle weakness supporting your facet joints. In that case, it is even easier to lock a facet joint repeatedly.

What are the Symptoms of a Locked Thoracic Facet Joint?

Patients experiencing a locked thoracic facet joint will typically notice the pain as one of the primary symptoms. This injury manifests as mid-back or ribcage pain and may potentially cause referred pain around the chest wall.

When a facet joint becomes locked, movement away from the locked position becomes difficult. For example, arching backward may be challenging if the joint is locked in a flexed forward position. The reverse is also true. Muscle spasms may be a protective mechanism for the injured facet joint in acute phases.

The initial injury can occur days or occasionally weeks before symptoms become apparent.

Patients commonly experience decreased movement, pain, or difficulty when stretching. Neighbouring joints may exhibit excessive movement, leading to pain on the opposite side of the locked facet joint. This excessive movement can result in conditions such as chest or rib pain.

Medical professionals refer to recurrent cases of this problem as thoracic facet joint syndrome. Weak stability muscles that fail to control the movement of the spine are the most common cause of this syndrome.

How is a Thoracic Facet Joint Injury Diagnosed?

Your spinal physiotherapist diagnoses a thoracic facet joint injury most accurately through a hands-on examination. They will utilise their professional expertise to confirm the specific facet joint issue and determine whether it is locked, stiff, or unstable. While X-rays, MRIs, and CT scans can identify arthritic changes and fractures, they cannot detect a locked facet joint.

Please consult your physiotherapist to receive personalised advice and treatment for managing thoracic facet joint pain.

Thoracic Facet Joint Syndrome Treatment

Treating a locked facet joint is a relatively straightforward process. Your physiotherapist will promptly identify the specific locked facet joint and proceed to unlock it. For this purpose, physiotherapists typically employ a painless joint-releasing technique.

The subsequent step involves restoring the full range of motion and initiating strengthening or other appropriate exercises to prevent future occurrences. Since each individual is unique, your physiotherapist will tailor your treatment plan based on the specific deficits identified during the examination.

Unstable Thoracic Facet Joint Treatment

Treating unstable or hypermobile facet joints requires a distinct approach from locked facet joints. Since these joints already exhibit excessive movement, further loosening of the joint is unlikely to be beneficial. Instead, patients with hypermobile facet joints respond better to muscle control and stabilisation programs. It is advisable to consult with your physiotherapist to obtain their professional opinion on the matter. Your physiotherapist will provide guidance and assistance in this regard.

Rib Joints

Rib joint dysfunction can complicate thoracic facet joint syndrome, leading to pain and stiffness in the ribcage. The costovertebral and costotransverse joints facilitate the movement between the spine and ribs.

What Results Can You Expect?

Physiotherapy relieves most patients experiencing facet joint pain (Hu et al., 2006). In the case of locked facet joints, improvement is usually observed immediately after unlocking. However, the progress beyond that point depends on various factors, such as the duration of joint locking, the underlying cause, and the availability of motion in adjacent joints. Based on their examination, your physiotherapist will provide you with specific guidelines tailored to your condition. Rehabilitation of facet joint instability may require more time and focused muscle strengthening. It is advisable to consult your treating physiotherapist for their professional opinion and to obtain a personalised treatment plan.

Other Treatment Options

Massage can effectively relieve muscle spasms and facilitate the release of facet joint spasms.

Acupuncture can provide targeted relief for muscle spasms and facet pain, whether through localised acupuncture or dry needling techniques. It is advisable to consult your physiotherapist for further advice on this treatment option.

Medical professionals may utilise thoracic facet joint injections to confirm a diagnosis and provide short-term relief, typically lasting a week or two. However, research suggests long-term exercise is more effective for patients than facet joint injections (Mayer et al., 2004).

In chronic cases, unresponsive to physiotherapy, radiofrequency treatment is an option. Radiofrequency cauterises the nerve, providing temporary pain relief. However, the pain typically returns when the nerve regrows, usually within a few months.

In summary, every case of facet joint pain is unique. Please consult your physiotherapist for the most suitable treatment plan and seek their professional opinion.