C4–C5 Facet Joint Syndrome is a condition affecting the small joints located between the fourth (C4) and fifth (C5) cervical vertebrae in the neck. These facet joints facilitate movement and provide stability to the spine.
C4–C5 facet joint syndrome is a form of neck pain that arises when the small articulations (facet or zygapophyseal joints) between the fourth and fifth cervical vertebrae become irritated, inflamed, or degenerated. These joints normally allow smooth, gliding movements of the neck while providing stability; when they malfunction, patients experience deep, aching pain in the back of the neck that may radiate into the shoulders or arms. PhysioPediaDesert Institute for Spine Care
Anatomy
Structure & Location.
Each cervical vertebra has two superior and two inferior articular processes. At the C4–C5 level, the inferior articular process of C4 meets the superior articular process of C5, forming a synovial facet joint. The joint surfaces are covered by hyaline cartilage and enclosed by a fibrous capsule containing synovial fluid, which reduces friction during movement. PhysioPedia
Origin & “Insertion.”
Although bones don’t strictly “originate” and “insert,” the articular processes act like functional anchors: the inferior facet of C4 “originates” the joint surface, and the superior facet of C5 “receives” or “inserts” into it, enabling the two vertebrae to glide smoothly over one another. PhysioPedia
Blood Supply.
Small branches of the ascending cervical arteries and vertebral arteries supply the capsule and surrounding ligaments of the C4–C5 facet joint, providing nutrients and helping with repair when mild injuries occur. PhysioPedia
Nerve Supply.
Sensory fibers from the medial branches of the dorsal rami of C4 and C5 spinal nerves innervate this joint. Cadaver studies show that at lower cervical levels, including C4–C5, one or two medial branches transmit pain signals when the joint is irritated. PMC
Primary Functions
Stability: Prevent excessive forward (anterior) or backward (posterior) slipping of vertebrae.
Movement Guidance: Channel rotation, flexion, and extension to safe ranges.
Load Sharing: Transfer compressive forces across the cervical spine.
Proprioception: Sense joint position and movement via mechanoreceptors.
Shock Absorption: Synovial fluid cushions impacts from sudden movements.
Protection of Neural Structures: Maintain alignment to safeguard spinal cord and nerve roots. PhysioPedia
Types
Facet joint syndrome at C4–C5 can arise from several distinct pathological processes:
Osteoarthritis (Degenerative): Wear-and-tear breakdown of cartilage with osteophyte (bone spur) formation.
Hypertrophied Superior Articular Process (HSAP): Bony overgrowth of the articular process that narrows the joint space.
Synovial (Facet) Cyst: Fluid-filled sac protruding from the joint capsule, sometimes compressing nerves.
Septic Arthritis: Infection invading the facet joint, often via bloodborne bacteria.
Crystal Deposition (Gout/CPPD): Uric acid or calcium pyrophosphate crystals inflame the joint capsule.
Inflammatory Spondyloarthropathies: Systemic conditions like ankylosing spondylitis or psoriatic arthritis affecting the joint lining.
Traumatic Injury: Acute sprains, dislocations, or fractures disrupting the joint capsule.
Congenital Malformations: Abnormal facet orientation (tropism) leading to uneven wear.
Post-surgical Arthropathy: Degeneration following neck surgery or fusion at adjacent levels.
Facet Joint Sprain or Subluxation: Capsule overstretch or partial dislocation without bone damage. PMCWikipedia
Causes
Age-related degeneration: Natural cartilage thinning over decades increases joint wear.
Repetitive strain: Constant neck movements in poor posture (e.g., desk work) stress the joint.
Whiplash injuries: Rapid flexion–extension trauma tears the joint capsule.
Osteoarthritis: Chronic cartilage loss and bone spur formation narrow the joint.
Facet tropism: Asymmetric facet orientation causes unequal loading and wear.
Spondylolisthesis: Vertebral slippage alters joint mechanics.
Spondylolysis: Stress fractures in the pars interarticularis lead to joint instability.
Poor posture: Forward-head position squeezes the posterior joints chronically.
Heavy lifting: Frequent overhead or weight-bearing tasks strain cervical facets.
Autoimmune conditions: Rheumatoid arthritis attacks the synovial lining.
Crystal arthropathies: Deposition of urate or calcium crystals inflames the joint.
Infection: Septic spread of bacteria into the joint capsule.
Facet cysts: Synovial outpouchings that mechanically irritate the joint.
Neoplastic invasion: Tumors eroding the articular surface.
Degenerative disc disease: Loss of disc height increases facet load.
Obesity: Extra weight augments axial stress on cervical facets.
Smoking: Reduces blood flow and impairs cartilage repair.
Genetic predisposition: Family history of early osteoarthritis.
Repeat sports injuries: Contact sports causing microtrauma.
Post-surgical changes: Altered biomechanics after cervical fusions. PhysioPediaDesert Institute for Spine Care
Symptoms
Deep neck ache: Constant dull pain in the back of the neck.
Morning stiffness: Reduced motion after waking, improving with activity.
Pain on extension: Discomfort when tilting the head backward.
Referred shoulder pain: Dull ache felt over the same side shoulder.
Headaches: Often at the base of the skull, called cervicogenic headaches.
Muscle spasms: Protective tightening of neck muscles around the joint.
Tenderness to touch: Point tenderness palpated over the C4–C5 region.
Limited range of motion: Difficulty turning or bending the neck fully.
Clicking or crepitus: Grinding sensation on movement.
Numbness or tingling: If nearby nerves are irritated.
Weakness in arm: Rare, but can occur if nerve roots are compressed.
Pain aggravated by posture: Worse after prolonged sitting or driving.
Pain relieved by flexion: Bending the neck forward may ease discomfort.
Radiating pain: Sharp, shooting pain radiating down the arm.
Sleep disturbance: Pain that wakes the patient at night.
Fatigue: Constant pain leads to tiredness and difficulty concentrating.
Balance issues: Rare, but severe pain can affect proprioception.
Limited daily activities: Difficulty in grooming, driving, or looking over the shoulder.
Emotional distress: Chronic pain often leads to irritability or mild depression.
Sensitivity to weather changes: Some patients report flare-ups in cold or damp conditions. atlanticspinecenter.comVerywell Health
Diagnostic Tests
Patient History & Physical Exam: Identifies pain patterns and movement restrictions.
Palpation: Detects point tenderness over the C4–C5 facets.
Spurling’s Test: Neck extension with rotation and axial load reproduces pain.
Facet Joint Block: Injection of local anesthetic into the joint; pain relief confirms diagnosis.
Medial Branch Block: Anesthetic injected around medial nerve branches; positive if pain subsides.
X-ray (AP/Lateral): Shows joint space narrowing, osteophytes.
Flexion-Extension X-rays: Detects abnormal movement or instability.
CT Scan: Detailed bony anatomy to grade degeneration (Pathria’s grading).
MRI: Shows synovial inflammation, cysts, and disc health.
Bone Scan: Highlights active inflammation in the joint.
Ultrasound-Guided Injection: Improves accuracy of diagnostic blocks.
Electromyography (EMG): Rules out primary nerve root issues.
Nerve Conduction Studies: Assesses nerve function if radicular symptoms.
Blood Tests: ESR, CRP, rheumatoid factor, uric acid to detect inflammatory or crystal arthropathy.
CT-Guided Synovial Biopsy: In suspected infection or crystal disease.
Facet Joint Arthrogram: Contrast injected to outline joint capsule integrity.
Provocative Injection under Fluoroscopy: Real-time imaging for accurate needle placement.
Quantitative Sensory Testing: Measures pain thresholds around the joint.
Dynamic Fluoroscopy: Observes joint movement in real time for subluxation.
Oswestry Neck Disability Index: Standardized questionnaire to quantify pain and disability. Spine-healthDesert Institute for Spine Care
Non-Pharmacological Treatments
Heat Therapy: Warm packs to reduce stiffness.
Cold Therapy: Ice packs to decrease inflammation.
Neck Stretching Exercises: Improves flexibility and reduces muscle tension.
Strengthening Exercises: Builds endurance of deep neck flexors and extensors.
Postural Correction: Ergonomic setup to maintain neutral spine.
Yoga & Pilates: Gentle movements to enhance core support.
Manual Therapy: Joint mobilizations by a physical therapist.
Myofascial Release: Massage to relieve connective tissue tightness.
Trigger Point Therapy: Direct pressure to relax tight muscle knots.
Dry Needling: Stimulates muscle relaxation and blood flow.
Acupuncture: Traditional technique to modulate pain pathways.
Chiropractic Adjustments: Gentle spinal manipulations to restore joint motion.
TENS (Transcutaneous Electrical Nerve Stimulation): Electrical currents to reduce pain perception.
Ultrasound Therapy: Deep heating to promote tissue healing.
Laser Therapy: Low-level lasers to reduce inflammation non-invasively.
Traction: Mechanical or manual pulling to decompress facet joints.
Kinesiology Taping: Supports muscles and joints during movement.
Cervical Pillows: Ergonomic support during sleep.
Education on Body Mechanics: Training in safe movement patterns.
Stress Management: Relaxation techniques to prevent muscle guarding.
Biofeedback: Teaches control over muscle tension and posture.
Hydrotherapy: Aquatic exercises reducing joint loading.
Weight Management: Reducing overall axial load on the spine.
Tai Chi: Slow martial-arts movements improving balance and flexibility.
Ergonomic Lending Devices: Neck braces or collars for short-term support.
Cervical Pillows: Memory-foam or contoured pillows for proper neck alignment.
Lifestyle Modification: Reducing activities that exacerbate symptoms.
Occupational Therapy: Adaptive strategies for daily tasks.
Mindfulness Meditation: Lowers pain sensitivity through focused attention.
Sleep Hygiene: Ensuring restful sleep to aid healing. Spine-healthVerywell Health
Drugs
NSAIDs (e.g., Ibuprofen): Reduce joint inflammation and pain.
COX-2 Inhibitors (e.g., Celecoxib): GI-safer anti-inflammatories.
Acetaminophen: Mild analgesic without anti-inflammatory action.
Muscle Relaxants (e.g., Cyclobenzaprine): Alleviate spasms.
Oral Corticosteroids (e.g., Prednisone): Short courses for severe flare-ups.
Topical NSAIDs (e.g., Diclofenac gel): Local pain relief with fewer systemic effects.
Capsaicin Cream: Depletes substance P to reduce pain over time.
Lidocaine Patches: Local anesthetic for focal pain control.
Gabapentinoids (e.g., Gabapentin): For neuropathic pain components.
Tricyclic Antidepressants (e.g., Amitriptyline): Low-dose for chronic pain modulation.
Serotonin-Norepinephrine Reuptake Inhibitors (e.g., Duloxetine): Broad pain inhibition.
Opioids (e.g., Tramadol): Reserved for severe, refractory pain.
Bisphosphonates (e.g., Alendronate): In metabolic bone disease-related facet arthropathy.
Uric-Lowering Agents (e.g., Allopurinol): In gouty facet involvement.
DMARDs (e.g., Methotrexate): In rheumatoid arthritis affecting facets.
Anti-TNF Agents (e.g., Etanercept): For ankylosing spondylitis-associated facet pain.
Bisphosphonates: In crystal deposition diseases with bone involvement.
Intra-articular Corticosteroids: Direct injection into facet joint.
Hyaluronic Acid Injection: Lubricates the joint in degenerative cases.
Platelet-Rich Plasma (PRP): Promotes tissue healing in early degeneration. NCBIVerywell Health
Surgical & Interventional Procedures
Medial Branch Radiofrequency Ablation: Destroys pain fibers to the joint capsule.
Facet Joint Denervation (Rhizotomy): Similar to RFA under CT/fluoroscopy.
Percutaneous Facet Joint Injection: Steroid and anesthetic for diagnostic and therapeutic use.
Endoscopic Facetectomy: Minimally invasive removal of hypertrophied facets.
Microsurgical Foraminotomy: Enlarges nerve exit zones if combined radiculopathy exists.
Spinal Fusion (C4–C5): Stabilization when severe instability is present.
Artificial Disc Replacement: In select cases with adjacent disc disease.
Synovial Cyst Resection: Removal of cysts compressing nerves.
Facet Joint Arthroplasty: Experimental replacement of the degenerated joint.
Open Facet Debridement: Surgical cleaning of osteophytes and inflamed tissue. PhysioPediaPMC
Prevention Strategies
Maintain Good Posture: Neutral spine alignment during sitting and standing.
Ergonomic Workstation: Screen at eye level, feet flat, shoulders relaxed.
Regular Exercise: Incorporate cervical strengthening and flexibility routines.
Weight Control: Reduces axial load on cervical spine.
Smoking Cessation: Improves microvascular blood flow to joints.
Balanced Diet: Supports cartilage health with vitamins C, D, and collagen.
Avoid Repetitive Strain: Take frequent breaks during computer work.
Safe Lifting Techniques: Keep loads close to the body, avoid overhead strain.
Neck Support During Sleep: Use ergonomic pillows or neck rolls.
Early Treatment of Neck Injuries: Prompt medical care for whiplash or trauma. Wexner Medical CenterVerywell Health
When to See a Doctor
Seek prompt evaluation if you experience:
Severe or worsening neck pain that does not improve with home care.
Neurological signs like arm weakness, numbness, or tingling.
Limited ability to turn your head, interfering with daily activities.
Night pain disrupting sleep or rest.
Systemic symptoms such as fever, weight loss, or fatigue suggesting infection. Verywell HealthWexner Medical Center
Frequently Asked Questions
1. Can C4–C5 facet joint syndrome heal on its own?
Mild cases may improve with rest and conservative care, but persistent degeneration often requires targeted treatment.
2. Is facet joint syndrome the same as a herniated disc?
No; facet syndrome involves the small posterior joints, while herniated discs affect the intervertebral disc core.
3. How long does recovery take after radiofrequency ablation?
Most patients resume normal activities within 1–2 days; full pain relief emerges over several weeks.
4. Are facet joint injections painful?
Local anesthetic is used; patients feel minimal discomfort during needle placement under imaging guidance.
5. Will physical therapy stop facet degeneration?
Therapy won’t reverse degeneration but can strengthen supporting muscles to reduce pain and slow progression.
6. Do I need imaging to diagnose facet joint syndrome?
Diagnosis starts clinically; imaging and diagnostic blocks confirm the source of pain.
7. Can facet syndrome cause headaches?
Yes; pain can refer upward, producing cervicogenic headaches at the base of the skull.
8. Are there specific supplements for joint health?
Glucosamine, chondroitin, and omega-3 fatty acids may support cartilage health, though evidence varies.
9. Is surgery common for facet syndrome?
No; fewer than 10% require surgical intervention, usually after failed conservative measures.
10. Can poor posture really damage these joints?
Chronic forward-head posture increases facet loading by up to 20%, accelerating wear.
11. What is the role of weight loss?
Reducing overall body weight decreases axial stress on the entire spine, including cervical facets.
12. How often can I repeat facet injections?
Typically limited to three times per year to avoid steroid-related side effects.
13. Are there lifestyle changes that help?
Yes; stress management, regular movement breaks, and ergonomic adjustments are key.
14. Can facet joint syndrome spread to other levels?
Adjacent levels may degenerate over time due to altered biomechanics, known as “adjacent-segment disease.”
15. What activities should I avoid?
Limit prolonged neck extension, heavy lifting, and repetitive overhead tasks until pain is controlled. WikipediaSpine-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.
