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Cheatography

Lumbar Facet Syndrome Cheat Sheet (DRAFT) by

Presentation, Management etc

This is a draft cheat sheet. It is a work in progress and is not finished yet.

Anatomy

- Sagittal orient­ation of upper facets help to limit rotation
- Frontal orietation of lower facts resist forward displa­cement
- Richly innervated by medial branches of dorsal rami + mechan­ore­cetors + nocice­ptors (can be hypers­ens­itised by inflam­matory process

Referral Patterns

Causes

- Repetitive capsular stress/ low level trauma
- Compre­ssion and extension of lumbar spine (causes inferior articular procces to pivot about the pars and stretch the capsule)
- Causes inflam­mation and joint dysfun­ction + intraa­rti­cular adhesions + degene­ration of the facet joints
- OA
- Hx of trauma
- Systemic arthro­pathy
- Obesity

Presen­tation

- Nocice­ptive stimul­ation causes back/leg pain
- LBP radiating to flank, hip and thigh
- Consider other pathology if there are radicular complaints
- Ipsila­teral fashion due to the medial branch of dorsal ramus does not cross the midline
- Stiffn­ess­/mo­rning stiffness common (degen­erative changes)
- Relief with recumbancy
- -ve Valsalva, normal gait with no muscle spasm
- Localised tenderness over the affected facet joint
- Muscle guarding
- ROM - ext
- +ve Kemps test
- Check for postural imbalances and gluts (extra pressure on facet joints)
- +ve Spinal percussion
- Neurol­ogical exam normal
- VAS, ROBDI, RMBDI, RAND 36, BDQ

Imaging

Only if red flags:
Severe­/pr­ogr­essive neurol­ogical deficits
Hx of cancer
Unexpl­ained Weight loss
Bone Disease
Systemic Disease
Inflam­matory Arthro­pathy (AS)
Steroid use
Immune Suppre­ssion
Fever
Nocturnal Pain
Prior Lx surgery
Severe congenital defect­/in­sta­bility
Pain is severe, progre­ssive, prolonged or unaffected by positiion

DDx

- Inters­egm­ental joint dysfun­ction
- Myofascial Pain
- Spondy­lolysis
- Spondy­lol­ist­hesis
- Sprain­/Strain
- Disc lesion
- F#/com­pre­ssion f#
- DJD/DDD
- Stenosis
- Neoplasm
- Infection
- Inflam­matory Arthopathy
- SI Dysfun­ction
- Hip OA/pat­hology
- AAA
- GI, GU referred pain

Management

- SMT Tx, Lx, EMT for SI and Pelvis - produces facet joint gapping and breaks up adhesions (12 visits over 6 weeks)
- Criteria for effect­iveness for SMT:
pain lasting >16 days
No symptoms distal to knee
Low fear avoidance (FABQ <19)
Hip internal rotation >35 degrees
Hypomo­bility of at least one lx segment
- Myofascial release of Lx Erectors, QL, Hip flexors, hip rotators, gluteal muscles, pirifo­rmis, hamstrings , iliolumbar ligament
- Flexab­ility exercises - knee to chest and hamstring stretch
- Rehab = neutral spine posture + Spinal stabil­isation exercises (side bridge, dead bug, bird dog, hip abductor streng­the­ning)
- Postural correction
- Heat/Ice
- Ultrasound
- Limits on heavy activity (lifting mechanics, work activites, sleep positions, shoe wear)
- Consider Radiof­req­uency ablation if: failure to show improv­ement with conser­vative care