C4–C5 Facet Joint Arthritis

C4–C5 facet joint arthritis is a degenerative condition affecting the small paired joints (zygapophyseal or facet joints) between the fourth (C4) and fifth (C5) cervical vertebrae. These facet joints guide and limit neck movements while bearing a portion of the spinal load. When the cartilage lining these joints breaks down over time, bone-on-bone contact, inflammation, and osteophyte (bone spur) formation occur, leading to pain, stiffness, and reduced function in the neck region. Physio-pediaNCBI

Anatomy

Structure and Location

The C4–C5 facet joints are synovial joints formed by the articulation of the inferior articular process of C4 with the superior articular process of C5. They lie posteriorly, one on each side of the spinal canal, and are lined with smooth hyaline cartilage. A fibrous joint capsule surrounds each joint, sealing in synovial fluid that lubricates the articular surfaces and minimizes friction during neck movements. Spine-healthe-algos.com

Origin and Insertion

Unlike muscles, joints do not have origins and insertions. Instead, the joint capsule and supporting ligaments anchor directly to the bony margins of the articular facets at C4 and C5. These attachments stabilize the joint and contain synovial fluid, preventing excessive movement while allowing smooth gliding motions between adjacent vertebrae. Physio-pediaSpine-health

Blood Supply

Arterial blood to the C4–C5 facet joints is delivered primarily by the posterior spinal branches of the segmental spinal arteries, including branches of the ascending cervical and vertebral arteries. These small vessels penetrate the joint capsule and synovial membrane, nourishing the articular cartilage. Venous drainage occurs via the internal vertebral venous plexus and basivertebral veins, which channel blood back into the segmental veins. HomeResearchGate

Nerve Supply

Sensory innervation of the C4–C5 facet joints is provided by the medial branches of the dorsal rami of the C4 and C5 spinal nerves. Each facet joint receives nerves from the medial branch above and the branch below, allowing pain signals arising in the joint to be transmitted centrally when the joint is inflamed or irritated. PMCPMC

Functions

The C4–C5 facet joints perform six essential roles:

1. Stabilization: Preventing excessive forward or backward slippage of vertebrae.

2. Load Sharing: Bearing part of the axial load alongside intervertebral discs.

3. Motion Guidance: Directing and limiting motions of flexion, extension, lateral bending, and rotation.

4. Protective Limitation: Restricting extreme movements (hyperflexion/hyperextension) to safeguard the spinal cord and nerves.

5. Load Distribution: Alleviating stress on intervertebral discs by sharing compressive forces.

6. Proprioception: Housing mechanoreceptors that provide feedback on neck position and movement. HomeSpine-health

Types

Facet joint arthritis at C4–C5 can be classified by underlying mechanism:

• Primary Osteoarthritis: Age-related wear-and-tear of cartilage and joint surfaces.

• Secondary Osteoarthritis: Accelerated degeneration following trauma, surgery, or adjacent segment disease.

• Inflammatory Arthritis: Autoimmune synovitis as seen in rheumatoid arthritis, ankylosing spondylitis, or psoriatic arthritis.

• Septic (Infectious) Arthritis: Bacterial invasion of the facet joint space causing acute inflammation.

• Crystal-Induced Arthritis: Deposition of monosodium urate (gout) or calcium pyrophosphate (pseudogout) crystals.

• Developmental/Hypertrophic Changes: Congenital anomalies or hypertrophy leading to early degeneration. Spine ConnectionVerywell Health

Causes

1. Age-Related Degeneration: Natural cartilage wear over decades.

2. Repetitive Neck Motion: Chronic microtrauma from frequent flexion/extension.

3. Poor Posture: Prolonged forward head position increases facet stress.

4. Whiplash Injury: Sudden acceleration-deceleration trauma.

5. Spinal Instability: Ligament laxity or spondylolisthesis increasing joint load.

6. Degenerative Disc Disease: Disc height loss transfers load to facet joints.

7. Congenital Facet Dysplasia: Abnormal facet shape from birth.

8. Adjacent Segment Disease: Post-fusion accelerated wear at adjacent levels.

9. Obesity: Excessive body weight intensifying spinal compression.

10. Occupational Strain: Heavy lifting or overhead work stress.

11. Smoking: Impaired cartilage nutrition and healing.

12. Rheumatoid Arthritis: Immune-mediated synovial inflammation.

13. Ankylosing Spondylitis: Chronic axial inflammation and fusion.

14. Psoriatic Arthritis: Joint inflammation linked to psoriasis.

15. Septic Arthritis: Joint infection by bacteria.

16. Gout/Pseudogout: Crystal deposits provoking inflammation.

17. Diabetes Mellitus: Microvascular changes impair joint health.

18. Genetic Predisposition: Family history of osteoarthritis.

19. Vitamin D Deficiency: Poor bone and cartilage maintenance.

20. Osteoporosis: Altered biomechanics increasing facet load. Spine-healthSpine Connection

Symptoms

1. Localized neck pain at C4–C5

2. Morning stiffness in the neck

3. Limited range of motion (flexion/extension)

4. Muscle spasms and tightness

5. Referred pain to the shoulder top

6. Occipital headaches

7. Upper back pain between shoulder blades

8. Crepitus (clicking or grinding)

9. Tenderness on palpation

10. Pain worsened by neck extension

11. Relief with neck flexion

12. Pain with head rotation

13. Numbness or tingling in arms

14. Weakness in shoulder or arm muscles

15. Radiating arm pain

16. Sleep disturbances due to pain

17. Fatigue from chronic discomfort

18. Neck muscle atrophy over time

19. Anxiety or depression from ongoing pain

20. Reduced quality of life and activity avoidance Spine-healthVerywell Health

Diagnostic Tests

1. Physical examination (palpation, range-of-motion)

2. Spurling’s test (nerve root provocation)

3. Facet loading test (extension-rotation)

4. Joint palpation for tenderness

5. Neurological exam (reflexes, sensation)

6. Cervical X-rays (osteophytes, joint space)

7. Flexion-extension radiographs (instability)

8. CT scan (detailed bone evaluation)

9. MRI (soft-tissue and inflammation)

10. SPECT bone scan (active bone turnover)

11. Technetium bone scan (inflammation)

12. Discography (disc vs facet pain differentiation)

13. Ultrasound (limited role)

14. Diagnostic facet joint injection (anesthetic)

15. Medial branch nerve block (diagnostic)

16. Double-block protocol (confirmatory)

17. MR arthrography of facet joints

18. EMG/nerve conduction studies

19. Fluoroscopic-guided CT facet injection

20. Laboratory tests (ESR, CRP, rheumatoid factor) Physio-pediaHonorHealth

Non-Pharmacological Treatments

1. Heat therapy (warm packs)

2. Cold therapy (ice packs)

3. Joint mobilization by a physical therapist

4. Therapeutic massage

5. Chiropractic spinal adjustments

6. Structured physical therapy programs

7. Range-of-motion exercises

8. Deep neck flexor strengthening

9. Postural training and ergonomic corrections

10. Mechanical cervical traction

11. Yoga for neck flexibility

12. Pilates for core stabilization

13. Tai chi for balance and mobility

14. Kinesio taping for support

15. Acupuncture sessions

16. Dry needling of trigger points

17. TENS (electrical stimulation)

18. Therapeutic ultrasound

19. Low-level laser therapy

20. Biofeedback for muscle relaxation

21. Ergonomic workstation setup

22. Cervical pillow for sleep posture

23. Weight management programs

24. Stress reduction techniques

25. Aquatic (water-based) therapy

26. Soft cervical collar (short-term)

27. Prolotherapy injections

28. Mindfulness meditation

29. Activity pacing and lifestyle modification

30. Ergonomic driving headrest alignment Physio-pediaUCHealth

Drugs

1. Ibuprofen – NSAID for pain and inflammation

2. Naproxen – long-acting NSAID

3. Diclofenac – topical or oral NSAID

4. Celecoxib – selective COX-2 inhibitor

5. Aspirin – anti-inflammatory in low doses

6. Acetaminophen – non-opioid analgesic

7. Tramadol – weak opioid for moderate pain

8. Codeine – mild opioid analgesic

9. Morphine – strong opioid (short-term)

10. Cyclobenzaprine – muscle relaxant

11. Baclofen – central muscle relaxant

12. Gabapentin – neuropathic pain agent

13. Pregabalin – neuropathic pain agent

14. Amitriptyline – TCA for chronic pain

15. Duloxetine – SNRI for musculoskeletal pain

16. Topical diclofenac gel

17. Capsaicin cream (topical)

18. Lidocaine patch (local anesthesia)

19. Prednisone – oral corticosteroid (short course)

20. Methylprednisolone – injectable steroid for facet joints Spine ConnectionDr. Craig Best

Surgical and Interventional Procedures

1. Radiofrequency ablation (medial branch nerve)

2. Endoscopic facet rhizotomy

3. Cervical facet joint denervation

4. Posterior cervical fusion at C4–C5

5. Anterior cervical discectomy and fusion (ACDF C4–C5)

6. Posterior cervical laminectomy with fusion

7. Facetectomy with fusion

8. Foraminotomy at C4–C5

9. Artificial disc replacement (C4–C5)

10. Posterior dynamic stabilization devices Weill Cornell NeurosurgeryHealth

Prevention Strategies

1. Maintain correct head and neck posture

2. Perform regular neck strengthening exercises

3. Use ergonomic chairs and desks

4. Avoid lifting heavy loads incorrectly

5. Take frequent breaks from prolonged sitting

6. Keep a healthy body weight

7. Quit tobacco to improve joint health

8. Sleep with cervical support pillows

9. Warm up before physical activity

10. Practice proper lifting techniques Mayo Clinic OrthopedicsUCHealth

When to See a Doctor

You should consult a healthcare professional if neck pain persists more than 4–6 weeks, worsens at rest or awakens you at night, or is accompanied by arm numbness, tingling, or weakness. Seek immediate care for sudden loss of bladder or bowel control, high fever, or after a significant neck injury. Early assessment ensures accurate diagnosis and timely treatment to prevent further joint damage and neurological complications. Verywell HealthSpine-health

Frequently Asked Questions

1. What is facet joint arthritis?
Facet joint arthritis is wear-and-tear degeneration of the small joints between vertebrae, leading to cartilage loss, bone spur formation, and joint inflammation. Verywell Health

2. What causes C4–C5 facet joint arthritis?
Primary causes include aging, repetitive neck motions, poor posture, trauma, disc degeneration, and inflammatory diseases like rheumatoid arthritis. Spine-health

3. What are the common symptoms?
Symptoms include neck pain, stiffness, reduced motion, muscle spasms, headaches, and referred shoulder or arm discomfort. Verywell Health

4. How is it diagnosed?
Diagnosis involves clinical exam, imaging (X-ray, CT, MRI), and diagnostic injections such as medial branch nerve blocks. Physio-pedia

5. Can facet arthritis be cured?
There is no cure for osteoarthritis, but conservative treatments and interventions can effectively manage pain and improve function. NCBI

6. What treatments are available?
Treatment ranges from physical therapy and medications to injections (steroids, radiofrequency ablation) and, if needed, surgical fusion or decompression. Spine Connection

7. Are exercises helpful?
Yes. Targeted range-of-motion and strengthening exercises stabilize the neck, relieve pressure on facet joints, and reduce pain. Complete Physio

8. What medications are commonly used?
NSAIDs (ibuprofen, naproxen), acetaminophen, muscle relaxants (cyclobenzaprine), neuropathic agents (gabapentin), and short courses of steroids are typical. Spine Connection

9. Is surgery necessary?
Surgery is rarely first-line. It’s considered when conservative and minimally invasive treatments fail or when neurological deficits develop. Health

10. How long is recovery after surgery?
Recovery varies by procedure but typically involves 6–12 weeks of limited activity and physical therapy for fusion surgeries. Verywell Health

11. Can I prevent facet joint arthritis?
Maintaining good posture, regular neck exercises, ergonomic work habits, and healthy weight control can reduce risk. UCHealth

12. What is a medial branch nerve block?
It’s a diagnostic injection of anesthetic near the nerves supplying the facet joint; relief confirms the joint as the pain source. Physio-pedia

13. Are there risks with radiofrequency ablation?
Risks include temporary numbness, local bleeding, and very rarely nerve injury. Most patients tolerate it well with lasting pain relief. Health

14. How can I manage pain at home?
Use heat or cold packs, gentle stretching, over-the-counter NSAIDs, and maintain proper posture during daily activities. Mayfield Brain & Spine

15. When should I seek urgent care?
If you develop sudden severe neck pain after injury, loss of limb function, bladder/bowel incontinence, or signs of infection (fever, chills). Verywell Health

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The article is written by Team Rxharun and reviewed by the Rx Editorial Board Members

Last Updated: May 04, 2025.

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