Thoracic Facet Joint Pain
Thoracic Facet Joint Pain
Thoracic Facet Arthropathy / Thoracic Facet Syndrome
What is Thoracic Facet Joint Pain?
Thoracic facet joint pain is also commonly referred to as thoracic facet joint syndrome, facet joint disease, facet joint sprain, but mostly it is a pain caused by a facet joint injury.
Your facet joints are also known as zygapophyseal, apophyseal, or Z-joints. They are synovial joints between the vertebrae of your spine. There are two facet joints (left and right) in each spinal motion segment.
Each section of your spine has facet joints. You may hear them referred to as your cervical facet joints (neck), thoracic facet joints (mid-back) and lumbar facet joints (low back). Biomechanically, the function of each pair of facet joints is to guide and limit the movement of that spinal motion segment. Facet joint pain is one of the most common causes of neck pain, back pain and thoracic spine pain.
What Causes Thoracic Facet Joint Pain?
Facet joint motion can be disturbed by injury. Joint action can stiffen – known as hypomobility. Alternatively, joint movement can become excessive – known as hypermobility.
What Causes Thoracic Facet Joint Hypomobility?
Facet joint hypomobility can be caused by:
- locked facet joint,
- facet joint arthritis,
- degenerative facet joint osteophytes (bone spurs),
- joint capsule scarring, thickening or shortening, or
- protective muscle spasm.
In other words, a facet joint can stiffen due to a slow degeneration or due to uncontrolled motion, which is where your local muscle strength is essential to stabilise and control your facet joints.
What Causes Thoracic Facet Joint Hypermobility?
Trauma usually causes hypermobility. Examples include:
- Overstretched ligaments, or
- Any disease that destroys the joints, 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.
If you have previously suffered an injury or have local muscle weakness supporting your facet joints, it is even easier to lock a facet joint repeatedly.
What are the Symptoms of a Locked Thoracic Facet Joint?
Pain is one of the first symptoms a patient will notice with a facet joint injury. A thoracic facet joint injury will cause mid-back or ribcage pain and potentially pain referred around your chest wall.
When a facet joint locks, you may not be able to move in the direction away from where it’s locked. For example, if the joint is locked in a flexed forward position, you will probably have difficulty arching backwards. The opposite also occurs. In acute phases, muscle spasms will attempt to protect the injured facet joint.
The initial injury can sometimes occur days or occasionally weeks earlier. Your body will attempt to compensate for the locked joint by the neighbouring joints moving more than they usually would. This excessive movement can often cause pain on the opposite side of the locked facet joint and may potentially lead to other conditions such as sciatica or arm pain. Most commonly, you will notice decreased movement and pain or difficulty stretching.
People who have this problem recurrently are said to have thoracic facet joint syndrome. The most common cause of thoracic facet joint syndrome is weak stability muscles that fail to control your spine’s movement.
How is a Thoracic Facet Joint Injury Diagnosed?
The most accurate diagnosis of a thoracic facet joint injury is via a hands-on examination from your spinal physiotherapist. Using their professional skills, they will confirm the specific facet joint problem and whether it is locked, stiff or unstable. X-rays, MRIs, and CT scans identify arthritic changes and fractures but cannot detect a locked facet joint.
Please consult your physiotherapist for specific advice regarding your thoracic facet joint pain management.
Thoracic Facet Joint Syndrome Treatment
The treatment for a locked facet joint is relatively simple. Your physiotherapist will quickly detect which facet joint is locked. Then proceed to unlock it. Usually, your physiotherapist will open a locked facet joint using a painless joint releasing technique.
The next step is to regain full motion and commence strengthening or other exercises to prevent a future recurrence. Everyone is slightly different, so your treatment will vary depending on what deficits your physiotherapist has found during your examination.
Unstable Thoracic Facet Joint Treatment
Unstable or hypermobile facet joints need to be treated entirely differently from a locked facet joint. The fact that the joint already moves excessively would suggest that further joint loosening is unlikely to assist a hypermobile facet joint.
These patients respond better to muscle control and stabilisation programs. Your physiotherapist will guide you.
Please check with your physiotherapist or doctor for their professional opinion.
Thoracic facet joint syndrome can be complicated by rib joint dysfunction. Costvertebral and costotransverse joints allow movement between your spine and ribs. Dysfunction can cause pain and ribcage stiffness.
What Results Can You Expect?
Physiotherapy will provide the majority of facet joint pain patients with complete relief. (Hu et al. 2006). Locked facet joints will usually start improving immediately post-unlocking. How they progress beyond that, depend on what other concomitant factors are present. How long has the joint been locked? What caused the locking? What adjacent joint motion there is available?
Based on your physiotherapist’s examination, they will be able to provide you with more strict guidelines. Facet joint instability will take longer to rehabilitate since it requires time and practice for muscle strengthening. Once again, please check with your treating physiotherapist for their professional opinion and treatment plan.
Other Treatment Options
Massage can be an excellent form of muscle spasm relief to allow your facet joint spasm to release.
Localised acupuncture or dry needling techniques can provide localised muscle spasms and facet pain relief. Ask your physiotherapist for more advice.
Thoracic Facet Joint Injections
Facet joint injections may confirm a diagnosis and provide short-term (a week or two) relief. Researchers have found that facet joint injections are less effective than patients who exercise in the long term. (Mayer et al. 2004)
Radiofrequency in chronic cases which do not respond to physiotherapy treatment is an option. Radiofrequency cauterises the nerve, providing pain relief for some time. The downside is that the pain returns typically when the nerve regrows within a few months.
Every case of facet joint pain is different. Would you please check with your physiotherapist for their professional opinion on what treatment plan is best for you?
Common Causes of Upper Back Pain & Injury
Thoracic Spine Conditions
- Scheuermann's Disease
- Spinal Stenosis
- Rib Stress Fracture
Nerve-Related / Referred Pain
Youth Spinal Pain
Teenager Neck & Back Pain
Teenagers can be particularly vulnerable to back pain, mainly due to a combination of high flexibility and low muscle strength and posture control.
The competitive athlete and most individuals who exercise regularly or maintain fitness and core stability control are less prone to spine injury and problems due to the strength and flexibility of supporting structures. Luckily, issues involving the lower lumbar spine are rare in athletes and account for less than 10% of sports-related injuries. Injuries do occur in contact sports and with repetitive strain sports. Your physiotherapist can assist in the resolution of any deficits in this area.
Sports such as gymnastics, cricket fast bowlers, and tennis have a higher incidence of associated lumbar spine problems related to repetitive twisting and hyper-bending motions.
Spondylolisthesis is a significant concern and needs to be appropriately treated by a physiotherapist with a particular interest in these types of injuries. Luckily, most injuries are minor, self-limited, and respond quickly to physiotherapy treatment.
Common Adolescent Spinal Injuries
Lower Back (Lumbar Spine)
Midback (Thoracic Spine)
Neck (Cervical Spine)
For specific advice regarding youth neck or back pain, please seek the professional advice of your trusted spinal physiotherapist or doctor.