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Script for video

For this assessment we have chosen the condition ‘facet joint syndrome’ of the lumbar spine. We
will begin by briefly discussing what facet joint syndrome is, the anatomy of facet joints and the
reason why they are associated with low back pain, questions that we would ask when taking the
history of a patient with low back pain and the cluster of orthopaedic tests that we would use to
assist with the diagnosis of facet joint syndrome.

Facet joint syndrome is an articular condition of the lumbar spine facet joints and their innervations
and it can produce both local and radiating pain. According to Perolat et al., 2018 lumbar facet joints
account for 15-45% of all low back pain.

The facet joints are synovial joints, with a synovial membrane supplying the joint surfaces with
synovial fluid. This fluid interacts with the articular cartilage to decrease friction between the joint
surfaces (Bergmann & Peterson, 2011). The facet joints, along with the intervertebral disc makes up
a spinal segment, known as a “three-joint complex” (Varlotta et al., 2010). The role of the facet joints
is to control excessive movement especially in rotation and extension, and therefore providing stability
for the spine.

The most common cause of facet joint syndrome is repetitive micro-trauma to the joint and the
capsule during repetitive hyperextension, and as a result of degenerative disc disease which results
in micro-instability.

Each facet joint is surrounded by a capsule, which is innervated by pain receptors and is one of the
structures in the lumbar spine that reacts to combinations of tension and compression movements
brought on by different postures and physical activity. Injury to the facet joints is caused by
excessive movement causing damage to the joint capsule, which in turn causes swelling,
inflammation and pain. The pain in turn causes a reactive muscle spasm, which is a protective
mechanism (Bergmann & Peterson, 2011).

Facet joints also have a meniscoid, which is a fold of synovial membrane that projects into the
articular cavities of facet joints, and this can become entrapped or pinched and can cause pain. The
meniscoid can become entrapped between the joint surface itself, which can lead to pain and
muscle spasm. The meniscoid can also become pinched when the joint is in a flexed position and the
meniscoid is drawn out of the joint but is then unable to reenter the joint space on extension. It gets
stuck against the edge of the bony lip or articular cartilage, causing a buckling of the capsule that
serves as a space-occupying lesion and pain is produced through capsular distention (Bergmann &
Peterson, 2011).

Facet joint degenerative osteoarthritis is the most common form of facet joint pain, closely tied to
degeneration of the intervertebral discs. Like in all synovial lined joints, osteoarthritis is a continuum
between loss of joint space, narrowing, loss of synovial fluid and loss of cartilage and bony
overgrowth. High-grade cartilage necrosis arises quite rapidly in facet joints. Inflammation generated
by degeneration of facet joints and surrounding tissues is believed to be a cause of local pain
(Perolat et al., 2018).
Bergmann, T., & Peterson, D. (2011). Chiropractic technique. St. Louis, Mo.: Elsevier/Mosby.

Perolat, R., Kastler, A., Nicot, B., Pellat, J., Tahon, F., & Attye, A. et al. (2018). Facet joint syndrome:
from diagnosis to interventional management. Insights Into Imaging, 9(5), 773-789. doi:
10.1007/s13244-018-0638-x

Varlotta, G., Lefkowitz, T., Schweitzer, M., Errico, T., Spivak, J., Bendo, J., & Rybak, L. (2010). The
lumbar facet joint: a review of current knowledge: part 1: anatomy, biomechanics, and
grading. Skeletal Radiology, 40(1), 13-23. doi: 10.1007/s00256-010-0983-4

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