Facet joint syndrome at the C5–C6 level—often called C5 facet joint syndrome—occurs when the small synovial joints between the inferior articular process of the C5 vertebra and the superior articular process of C6 become irritated or damaged. This irritation can arise from degeneration, inflammation, trauma, or altered biomechanics, and leads to local neck pain and referred pain into the shoulders or upper back. Facet joint syndrome produces both axial (directly at the joint) and radiating pain patterns due to the joint’s rich sensory innervation. PhysioPediaMedscape
Anatomy of the C5–C6 Facet Joint
Structure & Location
The C5–C6 facet joint is a paired, plane (gliding) synovial joint situated at the back of the C5 and C6 vertebral bodies. It lies posterior to the intervertebral disc and spinal canal, forming part of the rear “pillar” of the cervical functional spinal unit. Spine-healthWikipedia
Articular Surfaces (Origin & Insertion)
Origin: The joint’s upper half comprises the inferior articular facet of the C5 vertebra.
Insertion: The lower half is the superior articular facet of the C6 vertebra.
These smooth, cartilage-covered surfaces interlock to guide and control neck movements. WikipediaSpine-health
Blood Supply
Small branches from the ascending cervical artery (branch of the thyrocervical trunk) and the deep cervical artery (branch of the costocervical trunk) send radicular vessels into the C5–C6 joint capsule. These vessels nourish the synovium, joint cartilage, and subchondral bone. Turkish NeurosurgeryWikipedia
Nerve Supply
Sensory fibers arise from the medial branches of the dorsal rami of the C5 and C6 spinal nerves. These nerves run in bony grooves along the articular pillars, giving off articular branches that innervate the joint capsule, periosteum, and adjacent ligaments, carrying pain signals when the joint is irritated. PMCSpringerLink
Key Functions
Guide Motion: Directs gliding movements between C5 and C6, ensuring smooth flexion, extension, rotation, and lateral bending. PhysioPediaPhysioPedia
Constrain Excessive Movement: Limits over-rotation or over-extension, protecting the spinal cord and nerve roots. PhysioPediaPMC
Load Bearing: Shares compressive forces with the intervertebral disc, carrying up to 25% of axial load during extension. PMCMusculoskeletal Key
Shock Absorption: Synovial fluid and cartilage absorb and distribute impact forces during dynamic neck movements. MD Health ExpertsPMC
Stability: Works with ligaments and discs to maintain posterior column alignment and resist shear or torsional stresses. PMCPhysioPedia
Proprioception: Mechanoreceptors in the joint capsule send feedback on joint position and movement to the central nervous system. PMC
Types of C5 – C6 Facet Joint Syndrome
Degenerative (Osteoarthritic): Cartilage wear leads to joint space narrowing and osteophyte (bone spur) formation, causing chronic pain. PhysioPediaWikipedia
Traumatic (Post-Whiplash): Rapid hyperextension–hyperflexion injuries (e.g., car accidents) tear the capsule or articular cartilage, triggering acute pain. Spine-healthNorth Alabama Spine & Rehab
Inflammatory (Arthritic): Systemic conditions like rheumatoid arthritis inflame the synovium, erode cartilage, and destabilize the joint. MedscapePhysioPedia
Mechanical (Instability/Hypermobility): Congenital or acquired laxity allows excessive joint motion, leading to early degeneration and pain. PMCPhysioPedia
Common Causes
Age-Related Osteoarthritis: Degenerative cartilage loss from natural wear over decades. PhysioPediaWikipedia
Cervical Spondylosis: Bone spur (osteophyte) formation narrows the joint and irritates the capsule. Spine-healthPMC
Whiplash Trauma: Sudden flexion–extension jerks tear joint structures. Spine-healthNorth Alabama Spine & Rehab
Repetitive Motion: Chronic overuse in occupations (e.g., overhead work) stresses articular cartilage. PhysioPediaPMC
Poor Posture: Forward head carriage increases facet loading at C5–C6. Spine-healthPhysioPedia
Intervertebral Disc Degeneration: Loss of disc height shifts more load onto the facet joint. WikipediaSpine-health
Facet Joint Hypertrophy: Chronic degeneration leads to enlargement and reduced joint space. PhysioPediaPhysioPedia
Synovitis: Inflammation of the synovial lining from overuse or autoimmune attack. PhysioPediaHome
Rheumatoid Arthritis: Autoimmune erosion of the facet capsule and cartilage. MedscapePhysioPedia
Ankylosis (RA or SpA): Bony fusion of the joint end stage, reducing mobility and causing pain. PMCPolish Journal of Radiology
Spinal Instability: Ligamentous laxity allows pathological joint translation. PMCMedscape
Facet Overload: Excessive compressive forces from lifting heavy loads. PhysioPediaMusculoskeletal Key
Disc Herniation: Posterolateral disc bulge impinges on the joint capsule. WikipediaSpine-health
Post-Surgical Changes: Fusion above/below alters biomechanics, overloading C5–C6. HomePMC
Congenital Joint Malformation: Abnormal facet angle predisposes to wear. Wikipedia
Ankylosing Spondylitis: Inflammatory new bone formation stiffens and stresses facets. Polish Journal of Radiology
Septic Arthritis (Infection): Bacterial invasion of the joint causes acute pain. Verywell Health
Synovial Cyst Formation: Fluid-filled cysts compress capsule and nerves. PhysioPedia
Occupational Stress: Heavy lifting or vibration (e.g., jackhammer use). PhysioPediaPMC
Genetic Predisposition: Family history of early arthritis accelerates degeneration. Wikipedia
Common Symptoms
Localized Neck Pain: Dull ache directly over C5–C6. PhysioPediaMedscape
Referred Shoulder Pain: Pain radiates into the top of the shoulder blade. Dr. Craig BestDr. David Provenzano
Stiffness: Difficulty turning or tilting the head. PhysioPediaSpine-health
Muscle Spasm: Paraspinal muscle tightening around the joint. PhysioPediaJKMS Journal of Korean Medical Science
Crepitus: Clicking or popping during neck motion. Spine-healthMedscape
Headache: Often occipital or temporal from C5–C6 irritation. PhysioPediaMedscape
Referred Arm Pain: Less common, can mimic radiculopathy. Medscape
Reduced Range of Motion: Limited flexion/extension. Spine-healthJKMS Journal of Korean Medical Science
Tightness in Trapezius: Pain extending into upper back muscles. Dr. Craig BestDr. David Provenzano
Night Pain: Worse when lying on one side. PhysioPediaSpine-health
Pain with Extension: Looking up aggravates the joint. PhysioPediaMedscape
Pain with Rotation: Turning head to one side triggers discomfort. PhysioPediaJKMS Journal of Korean Medical Science
Tenderness to Palpation: Soreness when pressing over the joint. PhysioPediaDr. Craig Best
Symptom Fluctuation: Varies with activity level. PhysioPediaSpine-health
Referred Scapular Pain: Discomfort between shoulder blades. Dr. Craig BestDr. David Provenzano
Mild Numbness: Rare, due to inflammation near nerves. Medscape
Fatigue: Chronic pain leads to muscle tiredness. PhysioPediaJKMS Journal of Korean Medical Science
Locking Sensation: Joint catches during movement. PhysioPediaJKMS Journal of Korean Medical Science
Psychological Impact: Anxiety or depression from chronic pain. PhysioPediaMedscape
Activity Avoidance: Patients limit neck movements. PhysioPediaSpine-health
Diagnostic Tests
Clinical Exam: Palpation and movement tests. JKMS Journal of Korean Medical SciencePhysioPedia
Flexion–Extension X-Rays: Detect instability or degeneration. 维基百科，自由的百科全书
CT Scan: Detailed bone imaging for osteophytes. PMC
MRI: Visualizes joint capsule inflammation and nerve compression. MedscapePMCwelcomebackclinic.com
Diagnostic Medial Branch Blocks: Local anesthetic injection confirms pain source. JKMS Journal of Korean Medical Science
Intra-Articular Injections: Contrast-guided pain relief test. PhysioPedia
Bone Scan: Highlights increased metabolic activity in inflamed joints. PhysioPedia
Ultrasound: Guides injections and assesses synovial thickening. Medscape
EMG/NCS: Rules out nerve root entrapment. Wikipedia
Facet Loading Test (Kemp’s): Provokes pain by extending/rotating. PhysioPedia
Spurling’s Test: Excludes radiculopathy. PhysioPedia
Thermography: Detects heat from inflammation. Medscape
Blood Tests: ESR/CRP for systemic inflammation (RA). PMC
Facet Joint Pressure Measurement: Research tool. PhysioPedia
Gait/Posture Analysis: Identifies compensatory patterns. PhysioPedia
Manual Therapy Assessment: Dysfunction detection. JKMS Journal of Korean Medical Science
Capsular Distension Test: Slow injection to provoke pain. Wikipedia
Discography: Differentiates disc vs facet pain. Medscape
Kinematic MRI: Motion-based imaging. 维基百科，自由的百科全书
3D CT Reconstruction: Precise joint alignment view. PhysioPedia
Non-Pharmacological Treatments
Physical Therapy: Strengthens stabilizing muscles. PhysioPedia
Posture Correction: Ergonomic adjustments. PhysioPedia
Heat Therapy: Increases blood flow. PhysioPedia
Cold Packs: Reduces inflammation. PhysioPedia
Cervical Traction: Temporarily unloads the joint. PhysioPedia
Manual Mobilization: Restores normal gliding. PhysioPedia
Massage Therapy: Relieves muscle spasm. PhysioPedia
Acupuncture: Modulates pain pathways. PhysioPedia
Dry Needling: Targets trigger points. PhysioPedia
Ultrasound Therapy: Deep heat application. PhysioPedia
TENS: Electrical pain modulation. PhysioPedia
Kinesio Taping: Supports soft tissues. PhysioPedia
Cervical Collar (Short-term): Limits motion for acute flare. PhysioPedia
Yoga/Stretching: Improves flexibility. PhysioPedia
Pilates/Core Stabilization: Enhances posture. PhysioPedia
Biofeedback: Teaches muscle relaxation. PhysioPedia
Ultrashort Wave Diathermy: Deep tissue heating. PhysioPedia
Laser Therapy: Accelerates tissue healing. PhysioPedia
Hydrotherapy: Gentle aquatic exercises. PhysioPedia
Mind-Body Techniques: Reduces stress-related tension. PhysioPedia
Ergonomic Workstation Adjustments: Minimizes sustained neck load. PhysioPedia
Cervical Pillows: Optimizes sleep posture. PhysioPedia
Chiropractic Adjustments: High-velocity mobilizations. PhysioPedia
Spinal Decompression Tables: Intermittent traction. PhysioPedia
Vestibular Rehabilitation: For proprioceptive deficits. PhysioPedia
Ergonomic Phone Headsets: Avoids cradling phone. PhysioPedia
Education on Activity Modification: Limits aggravating tasks. PhysioPedia
Soft-Tissue Release: Myofascial techniques. JKMS Journal of Korean Medical Science
Trigger-Point Injections (Dry/Saline): For muscle knots. PhysioPedia
Cognitive-Behavioral Therapy: Addresses pain coping. PhysioPedia
Pharmacological Treatments
NSAIDs (e.g., Ibuprofen): Reduce inflammation and pain. PhysioPedia
COX-2 Inhibitors (e.g., Celecoxib): Gastro-safer anti-inflammatories. PhysioPedia
Acetaminophen: Mild analgesic option. PhysioPedia
Muscle Relaxants (e.g., Cyclobenzaprine): Relieves spasm. PhysioPedia
Topical NSAIDs (e.g., Diclofenac Gel): Local pain relief. PhysioPedia
Topical Capsaicin: Depletes substance P from nerve endings. PhysioPedia
Oral Corticosteroids (Short-term): For severe inflammation. PhysioPedia
Gabapentinoids (e.g., Gabapentin): For neuropathic pain components. PhysioPedia
Duloxetine: SNRI for chronic musculoskeletal pain. PhysioPedia
Opioids (Short-term): Rescue for intractable pain. PhysioPedia
Tramadol: Weak opioid with SNRI properties. PhysioPedia
Calcitonin: Off-label for bone pain. PhysioPedia
Bisphosphonates: In osteoporotic degeneration. Medscape
Disease-Modifying Antirheumatic Drugs (DMARDs): For RA-related facet pain. Medscape
Biologics (e.g., TNF Inhibitors): Severe RA cases. JKMS Journal of Korean Medical Science
Intra-Articular Steroid Injections: Direct anti-inflammatory relief. PMC
Medial Branch Blocks (Steroid + LA): Diagnostic and therapeutic. PMC
Radiofrequency Denervation (RF): Neurotomy of medial branches. PMC
Phenol Neurolysis: Chemical nerve destruction (rare). PhysioPedia
Platelet-Rich Plasma (PRP): Experimental regenerative therapy. PMC
Surgical Options
Facet Rhizotomy: Radiofrequency ablation of medial branches. Spine-health
Microdiscectomy with Facetectomy: When disc and facet both compress nerves. Spine-health
Posterior Cervical Fusion (ACDF): Stabilizes segment by fusing C5–C6. Spine-health
Lateral Mass Screw Fixation: Posterior stabilization technique. PMC
Endoscopic Facet Joint Denervation: Minimally invasive RF. Spine-health
Foraminotomy: Enlarges neural foramen, indirectly relieving facet stress. Spine-health
Facetectomy with Instrumentation: Removal of joint with plate-screw stabilization. Spine-health
Cervical Disc Replacement (ADR): Maintains motion, reduces facet overload. JKMS Journal of Korean Medical Science
Synovial Cyst Excision: Removes cyst compressing joint or canal. Spine-health
Facet Joint Fusion (Arthrodesis): Direct joint fusion in severe instability. PhysioPedia
Preventive Measures
Maintain Good Posture: Neutral head position to reduce facet load. PhysioPedia
Ergonomic Workstation: Screen at eye level, supportive chair. PhysioPedia
Regular Exercise: Strengthen cervical stabilizers (deep neck flexors). PhysioPedia
Weight Management: Reduces axial load on the spine. Musculoskeletal Key
Proper Lifting Technique: Bend hips/knees, not the neck. PhysioPedia
Neck Stretching Routine: Maintains flexibility of soft tissues. PhysioPedia
Avoid Prolonged Neck Positions: Micro-breaks during phone/computer use. PhysioPedia
Sleep with Cervical Support Pillow: Keeps cervical curvature. MD Health Experts
Stay Hydrated: Cartilage health relies on water content. PhysioPedia
Regular Check-ups: Early detection in high-risk individuals.
When to See a Doctor
If neck pain is severe, persistent beyond 4–6 weeks, worsens despite conservative care, or is accompanied by neurological signs (numbness, weakness, or bowel/bladder changes), seek medical evaluation promptly. Early diagnosis improves outcomes and prevents complications.
Frequently Asked Questions
What exactly is facet joint syndrome?
A pain condition from irritation of the small synovial joints in the spine, causing local and referred pain. MedscapeHow is C5–C6 facet syndrome different from a herniated disc?
Facet pain is more localized to the back of the spine and worsens with extension, whereas disc pain often radiates along a nerve root. PhysioPediaCan facet syndrome cause headaches?
Yes—upper cervical facet irritation can refer pain to the occiput, causing cervicogenic headaches. JKMS Journal of Korean Medical ScienceAre X-rays sufficient to diagnose facet syndrome?
X-rays show degeneration but require diagnostic blocks or MRI for confirmation. PMCIs facet syndrome curable?
It is manageable—treatments focus on pain relief and functional restoration; some cases benefit from ablation or fusion. PhysioPediaHow long does it take to recover?
Mild cases improve in weeks with therapy; chronic cases may need months of combined treatments. PhysioPediaCan exercise worsen facet pain?
Overextension or rotation may aggravate the joint; guided, gentle strengthening is key. JKMS Journal of Korean Medical ScienceWhat is the role of injections?
Diagnostic blocks confirm the source and steroid injections reduce inflammation directly in the joint. PhysioPediaAre opioids necessary?
Rarely—used only short-term for severe pain; focus on non-opioid strategies first. PhysioPediaCan wearing a collar help?
Short-term collars can rest the joint during acute flare but can weaken muscles if overused. Spine-healthIs surgery often required?
Most cases respond to conservative care; surgery is reserved for instability or failed nonsurgical treatments. PhysioPediaCan facet syndrome recur?
Yes—ongoing factors like poor posture or arthritis can cause flare-ups, so preventive measures are important. PhysioPediaWhat lifestyle changes help?
Ergonomic improvements, regular neck exercises, weight control, and posture awareness. PhysioPediaAre alternative therapies effective?
Acupuncture, massage, and yoga can complement mainstream treatments for symptom relief.When should I get imaging?
If conservative care fails in 4–6 weeks or red-flag symptoms (neurological deficits) appear.
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The article is written by Team Rxharun and reviewed by the Rx Editorial Board Members
Last Updated: May 04, 2025.
