C5–C6 facet joint arthritis is a form of wear-and-tear arthritis affecting the small paired joints that link the fifth and sixth cervical vertebrae in the neck. When the protective cartilage in these joints breaks down, it leads to inflammation, pain, stiffness, and decreased motion at that specific level of the spine Red Butte Pain SolutionsPhysio-pedia.
Anatomy
Structure and Location
The facet joints (also called zygapophyseal joints) are synovial joints formed by the inferior articular process of the vertebra above and the superior articular process of the vertebra below. The C5–C6 facet joint lies just behind the spinal canal, where it helps guide and limit the movements of the neck NCBISpine-health.
Origin and Insertion
Joints do not have muscle origins or insertions; instead, the C5–C6 joint forms where the bony projections (articular processes) of C5 meet those of C6. Each process is covered in smooth cartilage and enclosed by a joint capsule that permits sliding movements NCBIScienceDirect.
Blood Supply
The tiny vessels feeding the C5–C6 facet joint arise from branches of the vertebral artery and the ascending cervical artery. These arteries run along the sides of the vertebrae and send small branches into the joint capsule to nourish the cartilage and synovial lining Physio-pediaPhysio-pedia.
Nerve Supply
Sensory and pain signals from the C5–C6 facet joint travel along the medial branches of the dorsal rami of the C5 and C6 spinal nerves. These small nerves wrap around the joint and convey messages about pain and position (proprioception) back to the brain ResearchGateNCBI.
Functions
The C5–C6 facet joint performs six key roles:
Guides flexion and extension (bending forward and backward)
Limits excessive rotation (twisting)
Shares axial load bearing with the intervertebral disc
Absorbs shock to protect the disc
Provides proprioceptive feedback to the central nervous system
Maintains stability of the cervical spine during movement Physio-pediaPhysio-pedia.
Types
C5–C6 facet joint arthritis generally falls into two categories:
Primary degenerative arthritis: Develops gradually as the cartilage wears down with age and repeated use.
Secondary arthritis: Occurs due to another condition—such as trauma, infection, or inflammatory diseases like rheumatoid arthritis—accelerating joint breakdown beyond normal aging Physio-pediaNCBI.
Types of C5–C6 Facet Joint Arthritis
Degenerative (Osteoarthritis): Age-related wear of cartilage and joint space narrowingfwbsi.com.
Post-Traumatic: Following injuries like whiplash, which stress the joint capsuleMedscape.
Inflammatory (Rheumatoid, Psoriatic): Autoimmune attacks on synovial tissue; rheumatoid arthritis often involves C5–C6 after years of diseaseNCBI.
Septic: Rare bacterial infection of the joint, typically via bloodstream spread; requires antibiotics and sometimes surgeryPMC.
Metabolic (Gout, CPPD): Crystal deposition in the joint lining causing inflammation.
Adjacent Segment Disease: Degeneration above or below a fused segment increases stress at C5–C6.
Synovial Cyst-Associated: Fluid-filled cysts can grow from the joint capsule and compress nerves.
Neoplastic: Metastatic or primary tumors eroding the joint.
Causes
Facet joint arthritis at C5–C6 can result from multiple factors, often acting together:
Aging & Wear-and-Tear: Gradual cartilage breakdownVerywell Health.
Whiplash Trauma: Rapid flexion/extension injures joint capsuleMedscape.
Poor Posture (“Text Neck”): Forward head tilt increases joint loading.
Repetitive Stress: Heavy lifting or overhead work.
Previous Surgery: Altered biomechanics after fusion.
Obesity: Extra head-weight magnifies load.
Smoking: Impairs cartilage nutrition.
Genetics: Family history of osteoarthritis.
Inflammatory Diseases: RA, ankylosing spondylitis.
Crystal Deposition: Gout, CPPD in the joint lining.
Infection: Septic arthritis from bacteremia.
Facet Hypertrophy: Joint enlargement compresses structuresVerywell Health.
Synovial Cysts: Fluid accumulationPubMed.
Degenerative Disc Disease: Alters load-sharing.
Occupational Hazards: Vibration (e.g., jackhammer).
Trauma Fractures: Vertebral fractures affecting joint alignment.
Congenital Malformations: Abnormal facet orientation.
Adjacent Segment Disease: Stress transfer.
Poor Muscle Support: Weak neck muscles increase joint stress.
Nutritional Deficiencies: Poor cartilage repair.
Symptoms
Patients with C5–C6 facet arthritis may experience:
Neck Pain: Local ache or sharp pain.
Stiffness: Especially on waking.
Tenderness: Pain on pressing over the joint.
Reduced Range of Motion: Difficulty turning head.
Muscle Spasm: Neck muscle tightness.
Headache: Often at the back of the head.
Shoulder Pain: Referral to shoulder bladeDr. David Provenzano.
Arm Numbness/Tingling: If nerve roots are irritated.
Radiating Pain: Down the arm following the C6 dermatome.
Grinding Sensation: Crepitus with movement.
Pain with Extension: Looking up worsens pain.
Pain with Rotation: Turning head triggers discomfort.
Cervicogenic Headache: Head pain from neck origin.
Loss of Balance: Rare if spinal cord is compressed.
Fatigue: Chronic pain disrupts sleep.
Clicking Sounds: Audible joint noises.
Locked Neck: Temporary inability to move.
Weak Grip: From C6 nerve involvement.
Muscle Atrophy: Chronic nerve irritation.
Pain Fluctuation: Varies with activity and rest.
Diagnostic Tests
Physical Exam: Palpation, range-of-motion tests.
Spurling’s Test: Neck extension with side bending reproduces pain.
X-Ray: Shows joint narrowing, osteophytes.
CT Scan: Detailed bone imaging.
MRI: Soft-tissue detail; rules out disc disease.
Bone Scan: Highlights active degeneration.
SPECT-CT: Functional bone imaging.
Diagnostic Medial Branch Blocks: Local anesthetic relieves pain if joint is sourceDr. Craig Best.
Facet Joint Injection with Steroid: Therapeutic and diagnostic.
Ultrasound-Guided Injection: Real-time needle placement.
Electromyography (EMG): Assesses nerve irritation.
Nerve Conduction Study: Tests electrical signal along C6 nerve.
Laboratory Tests: ESR/CRP (inflammatory markers) for RA or infection.
Serum Uric Acid: For gout.
Joint Aspiration & Culture: If septic arthritis suspected.
Fluoroscopy: Live-x-ray guidance during injections.
Provocative Discography: Rules out discogenic pain.
Diagnostic Facet Arthroscopy: Rare; direct joint view.
Load Testing: Simulator-assisted stress X-rays.
Psychosocial Screening: Identify pain amplification factors.
Non-Pharmacological Treatments
The 2019 ACR guidelines strongly recommend non-drug approaches for osteoarthritis, which apply to facet arthritis in the neck:
Neck-Specific Exercise Programs (strength, flexibility)American College of Rheumatology.
Manual Therapy (mobilization)
Traction Therapy
Heat Therapy (moist heat packs)
Cold Packs
Transcutaneous Electrical Nerve Stimulation (TENS)
Acupuncture
Massage Therapy
Yoga & Pilates
Tai ChiMayo Clinic.
Ergonomic Adjustments (desk setup)
Posture Training
Cervical Collars (short-term)
Cognitive-Behavioral Therapy
Weight Management
Hydrotherapy (Aquatic Exercise)
Self-Management Education
Assistive Devices (neck pillows)
Ultrasound Therapy
Low-Level Laser Therapy
Neck Brace Weaning Programs
Balance Training
Deep Breathing & Relaxation
Smoking Cessation Support
Nutrition Counseling
Ergonomic Headsets
Activity Modification
Spinal Cord Stimulation (trial)
Mindfulness Meditation
Hydrocollator Packs
Pharmacological Treatments
Based on ACR and Mayo Clinic recommendations:
Oral NSAIDs (ibuprofen, naproxen)American College of Rheumatology.
Topical NSAIDs (diclofenac gel).
Acetaminophen (paracetamol).
COX-2 Inhibitors (celecoxib).
Muscle Relaxants (cyclobenzaprine).
Oral Steroids (short course prednisone).
Corticosteroid Injections into the facet joint.
Capsaicin Cream.
Duloxetine (for chronic musculoskeletal pain).
Tramadol (weak opioid).
Gabapentin (for neuropathic pain).
Amitriptyline (low-dose TCA).
Bisphosphonates (if osteoporosis coexists).
Disease-Modifying Antirheumatic Drugs (DMARDs) (for RA).
Colchicine (for gout).
Biologics (for inflammatory arthropathies).
Proton Pump Inhibitor (with chronic NSAID use).
Hyaluronic Acid Injections (off-label).
Epidural Steroid Injection (if radiculopathy).
Botulinum Toxin (adjunct for muscle spasmPMC).
Surgical Treatments
When conservative care fails, options include:
Radiofrequency Ablation (RFA) of medial branchesSpringerOpen.
Cryoablation of facet nervesSpringerOpen.
Medial Branch Neurotomy (open neurolysis)PMC.
Facet Joint Excision (Facetectomy)Medical News Today.
Anterior Cervical Discectomy & Fusion (ACDF) at C5–C6Mayfield Brain & Spine.
Cervical Artificial Disc Replacement (ADR) at C5–C6Spine-health.
Posterior Cervical Decompression & Fusion (multi-level)Globus Medical.
Posterior Cervical Laminectomy & FusionSpine Surgeon – Antonio Webb, MD.
Posterior Cervical LaminoforaminotomyVerywell Health.
Posterior Cervical Fusion with Instrumentation (rods/screws)ADR Spine.
Prevention Strategies
Maintain Good Posture (neutral head).
Regular Neck Exercises (strength & flexibility).
Ergonomic Workstation (screen at eye level).
Take Frequent Breaks from static positions.
Use Supportive Pillows for sleep.
Stay Active & Fit (cardio + strength).
Avoid Heavy Overhead Lifting.
Quit Smoking (improves tissue health).
Manage Weight to reduce load.
Early Treatment of neck injuries.
When to See a Doctor
Pain lasting >6 weeks despite home care.
Severe pain unrelieved by rest or medications.
Neurological signs: arm weakness, numbness, or tingling.
Bowel/bladder changes (rare).
Fever with neck pain (infection risk).
History of cancer with new neck pain.
When to See a Doctor
Seek professional care if you experience neck pain that lasts more than four to six weeks, steadily worsens, or is severe enough to limit daily activities. Sudden numbness, weakness in the arms, trouble controlling your bladder or bowels, difficulty swallowing, fever, or unexplained weight loss are urgent “red flags” that require prompt evaluation NCBIMayo Clinic Orthopedics.
Frequently Asked Questions
1. What is C5–C6 facet joint arthritis?
It’s a degenerative condition in which the small synovial joints between the fifth and sixth cervical vertebrae wear down, causing pain and reduced mobility in the neck Red Butte Pain Solutions.
2. What causes this condition?
Common causes include aging, repetitive neck motions, injuries (like whiplash), inflammatory diseases (e.g., rheumatoid arthritis), and poor posture over time NCBI.
3. What are the typical symptoms?
People often report chronic neck pain, stiffness (especially in the morning), headaches at the base of the skull, and sometimes pain radiating into the shoulders or arms Dr. David Provenzano.
4. How is it diagnosed?
Diagnosis relies on a physical exam, X-rays, CT or MRI scans, and sometimes diagnostic injections into the facet joint to confirm it as the pain source Mayo Clinic OrthopedicsSpine-health.
5. What non-drug treatments help?
Physical therapy, joint mobilization, posture training, heat/cold therapy, acupuncture, and ergonomic changes at work or in daily life can all reduce pain and improve function Physio-pedia.
6. When are injections used?
Corticosteroid or hyaluronic acid injections are considered when pain is moderate to severe and not controlled by physical therapy and medications Mayo Clinic Orthopedics.
7. Are there surgical options?
Yes—procedures such as radiofrequency ablation, facet fusion, or cervical fusion surgeries may be recommended if conservative treatments fail Mayo Clinic Orthopedics.
8. Can exercises really help?
Absolutely. Targeted neck stabilization and range-of-motion exercises strengthen muscles, improve posture, and relieve stress on the facet joint Physio-pedia.
9. How long does recovery take?
Recovery time varies: simple procedures like radiofrequency ablation allow return to normal activities in days, while fusion surgeries may require several weeks to months for full healing Spine-health.
10. Is facet joint arthritis curable?
There is no cure for the degenerative process, but symptoms can often be well managed through a combination of lifestyle changes, therapies, and medical treatments Physio-pedia.
11. Can lifestyle changes prevent it?
Yes—maintaining good posture, exercising regularly, keeping a healthy weight, and avoiding smoking all help protect the facet joints Home.
12. What is the long-term outlook?
Most people achieve satisfactory pain relief and maintain good neck function with ongoing conservative care; a small number may need more invasive treatments over time NCBI.
13. Can this arthritis cause headaches?
Yes—pain from the upper cervical facet joints can refer to the head, causing cervicogenic headaches that mimic migraines or tension headaches Red Butte Pain Solutions.
14. Are imaging tests safe?
X-rays and CT scans use low levels of radiation and are generally safe when clinically indicated; MRI uses no radiation and is safe for most people Mayo Clinic Orthopedics.
15. When should I see a specialist?
If your pain is severe, progressively worsening, not responding to initial treatments, or you have neurologic symptoms (numbness, weakness), consider referral to a spine specialist or pain management physician Spine-health.
Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.
The article is written by Team Rxharun and reviewed by the Rx Editorial Board Members
Last Updated: May 04, 2025.
