Cervical Facet Joint Injections in the Neck and Shoulder Pain

Abstract

The effects from cervical facet joint injections in those patients who have been complaining cervical zygapophyseal joint pain were compared. The patients were diagnosed originally as myofascial pain syndrome (MPS), cervical herniated nucleus pulposus (HNP), and whiplash-associated disorders (WAD). Patients with the zygapophyseal joints pain of C5-6 and C6-7 were classified by their pain origin as MPS, HNP, and WAD. All patients had been undergone cervical zygapophyseal joints injections with the mixture of lidocaine and triamcinolone unilaterally or bilaterally through the posterior approach under C-arm imaging guide. The therapeutic effects were compared with reduction of numeric rating scale (NRS) of pain before and immediately after blockade and symptom-free periods in each group after 12 months. Symptom durations before injections were 16.1±9.6, 4.6±1.9 and 4.1±1.1 months in each MPS, HNP, and WAD groups. The reductions of NRS immediately after the blockade among the three groups were not different. However, the symptom-free duration after blockade lasted longer in the HNP group than the other two groups. In patients with cervical zygapophyseal pain syndromes, the analgesic effect from cervical facet joint blocks lasted longer in cervical HNP than MPS or WAD.

Transforaminal versus Intra-Articular Facet Corticosteroid Injections for the Treatment of Cervical Radiculopathy: A Randomized, Double-Blind, Controlled Study

“…Neither intervention was associated with a clinically significant pain medication-intake reduction with time. An observational study by Kim et al in 2005 12 suggested that IFSI could be effective in patients with cervical disk herniation. Unfortunately, the study group appeared to be inhomogeneous and the methodology was incompletely described for drawing any sound conclusions from that study.…”

“…7 Although the exact prevalence of these devastating adverse events is unknown, some authors have questioned the continued use of TFSI, 8 while others advocate technical strategies to improve the safety of the procedure 9,10 or alternative approaches, which potentially carry fewer risks. 8,11 Preliminary work by Kim et al in 2005 12 and by Richarme et al in 2008 11 suggested that intra-articular facet steroid injections (IFSIs) could be effective in patients with cervical radiculopathy secondary to disk herniation. Anatomically, the facet joint ventral recess is in close proximity to the spinal nerve root.…”

Epidemiology, Diagnosis, and Treatment of Neck Pain

“…107 In a smaller study in 12 patients with cervicogenic headache that performed empirical radiofrequency denervation without diagnostic injections, 4 of 6 persons in the treatment group experienced success at 3 months, which favorably compared with 2 of 6 in the treatment group. 108 Although small uncontrolled studies have reported benefit with intra-articular corticosteroid injections, 109 the only placebo-controlled study reported no differences between the corticosteroid and local anesthetic control injections at 6-month follow-up. 110 Injections in the form of selective nerve root blocks (SNRBs) have also been advocated as a tool to identify symptomatic spinal levels and select patients for surgery.…”

All about pain pharmacology: what pain physicians should know

“…This means that anti-inflammatory drugs may be effective through either systemic administration or local infiltration. Therefore, in the case of inflamed knee joints, as with the diarthrodial joints, it seems more effective to use direct intra-articular injections than Kim, et al innervating nerve branch blocks [8][9][10]. The medial branch also innervates bones, including the posterior lamina and spinous process, ligaments, including the supraspinous ligament, interspinous ligament, and ligament flavum, erect muscles, skin, and subcutaneous tissues, as well as the facet joints [11].…”