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:
Stabilization: Preventing excessive forward or backward slippage of vertebrae.
Load Sharing: Bearing part of the axial load alongside intervertebral discs.
Motion Guidance: Directing and limiting motions of flexion, extension, lateral bending, and rotation.
Protective Limitation: Restricting extreme movements (hyperflexion/hyperextension) to safeguard the spinal cord and nerves.
Load Distribution: Alleviating stress on intervertebral discs by sharing compressive forces.
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
Age-Related Degeneration: Natural cartilage wear over decades.
Repetitive Neck Motion: Chronic microtrauma from frequent flexion/extension.
Poor Posture: Prolonged forward head position increases facet stress.
Whiplash Injury: Sudden acceleration-deceleration trauma.
Spinal Instability: Ligament laxity or spondylolisthesis increasing joint load.
Degenerative Disc Disease: Disc height loss transfers load to facet joints.
Congenital Facet Dysplasia: Abnormal facet shape from birth.
Adjacent Segment Disease: Post-fusion accelerated wear at adjacent levels.
Obesity: Excessive body weight intensifying spinal compression.
Occupational Strain: Heavy lifting or overhead work stress.
Smoking: Impaired cartilage nutrition and healing.
Rheumatoid Arthritis: Immune-mediated synovial inflammation.
Ankylosing Spondylitis: Chronic axial inflammation and fusion.
Psoriatic Arthritis: Joint inflammation linked to psoriasis.
Septic Arthritis: Joint infection by bacteria.
Gout/Pseudogout: Crystal deposits provoking inflammation.
Diabetes Mellitus: Microvascular changes impair joint health.
Genetic Predisposition: Family history of osteoarthritis.
Vitamin D Deficiency: Poor bone and cartilage maintenance.
Osteoporosis: Altered biomechanics increasing facet load. Spine-healthSpine Connection
Symptoms
Localized neck pain at C4–C5
Morning stiffness in the neck
Limited range of motion (flexion/extension)
Muscle spasms and tightness
Referred pain to the shoulder top
Occipital headaches
Upper back pain between shoulder blades
Crepitus (clicking or grinding)
Tenderness on palpation
Pain worsened by neck extension
Relief with neck flexion
Pain with head rotation
Numbness or tingling in arms
Weakness in shoulder or arm muscles
Radiating arm pain
Sleep disturbances due to pain
Fatigue from chronic discomfort
Neck muscle atrophy over time
Anxiety or depression from ongoing pain
Reduced quality of life and activity avoidance Spine-healthVerywell Health
Diagnostic Tests
Physical examination (palpation, range-of-motion)
Spurling’s test (nerve root provocation)
Facet loading test (extension-rotation)
Joint palpation for tenderness
Neurological exam (reflexes, sensation)
Cervical X-rays (osteophytes, joint space)
Flexion-extension radiographs (instability)
CT scan (detailed bone evaluation)
MRI (soft-tissue and inflammation)
SPECT bone scan (active bone turnover)
Technetium bone scan (inflammation)
Discography (disc vs facet pain differentiation)
Ultrasound (limited role)
Diagnostic facet joint injection (anesthetic)
Medial branch nerve block (diagnostic)
Double-block protocol (confirmatory)
MR arthrography of facet joints
EMG/nerve conduction studies
Fluoroscopic-guided CT facet injection
Laboratory tests (ESR, CRP, rheumatoid factor) Physio-pediaHonorHealth
Non-Pharmacological Treatments
Heat therapy (warm packs)
Cold therapy (ice packs)
Joint mobilization by a physical therapist
Therapeutic massage
Chiropractic spinal adjustments
Structured physical therapy programs
Range-of-motion exercises
Deep neck flexor strengthening
Postural training and ergonomic corrections
Mechanical cervical traction
Yoga for neck flexibility
Pilates for core stabilization
Tai chi for balance and mobility
Kinesio taping for support
Acupuncture sessions
Dry needling of trigger points
TENS (electrical stimulation)
Therapeutic ultrasound
Low-level laser therapy
Biofeedback for muscle relaxation
Ergonomic workstation setup
Cervical pillow for sleep posture
Weight management programs
Stress reduction techniques
Aquatic (water-based) therapy
Soft cervical collar (short-term)
Prolotherapy injections
Mindfulness meditation
Activity pacing and lifestyle modification
Ergonomic driving headrest alignment Physio-pediaUCHealth
Drugs
Ibuprofen – NSAID for pain and inflammation
Naproxen – long-acting NSAID
Diclofenac – topical or oral NSAID
Celecoxib – selective COX-2 inhibitor
Aspirin – anti-inflammatory in low doses
Acetaminophen – non-opioid analgesic
Tramadol – weak opioid for moderate pain
Codeine – mild opioid analgesic
Morphine – strong opioid (short-term)
Cyclobenzaprine – muscle relaxant
Baclofen – central muscle relaxant
Gabapentin – neuropathic pain agent
Pregabalin – neuropathic pain agent
Amitriptyline – TCA for chronic pain
Duloxetine – SNRI for musculoskeletal pain
Topical diclofenac gel
Capsaicin cream (topical)
Lidocaine patch (local anesthesia)
Prednisone – oral corticosteroid (short course)
Methylprednisolone – injectable steroid for facet joints Spine ConnectionDr. Craig Best
Surgical and Interventional Procedures
Radiofrequency ablation (medial branch nerve)
Endoscopic facet rhizotomy
Cervical facet joint denervation
Posterior cervical fusion at C4–C5
Anterior cervical discectomy and fusion (ACDF C4–C5)
Posterior cervical laminectomy with fusion
Facetectomy with fusion
Foraminotomy at C4–C5
Artificial disc replacement (C4–C5)
Posterior dynamic stabilization devices Weill Cornell NeurosurgeryHealth
Prevention Strategies
Maintain correct head and neck posture
Perform regular neck strengthening exercises
Use ergonomic chairs and desks
Avoid lifting heavy loads incorrectly
Take frequent breaks from prolonged sitting
Keep a healthy body weight
Quit tobacco to improve joint health
Sleep with cervical support pillows
Warm up before physical activity
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.
