Conditions We Treat
Thoracic Facet Joint Syndrome
What Is It?
Thoracic facet joint syndrome is a condition where the small joints in the back of the thoracic spine (facet joints) become inflamed, arthritic, or irritated, leading to localized or referred mid-back pain.
These joints guide and limit movement in the thoracic spine and play an important role in spinal stability.
Degeneration may occur gradually due to aging or increased mechanical stress, or more acutely following injury.
Common causes include:
- Osteoarthritis
- Repetitive strain or poor posture
- Spinal trauma
- Degenerative disc disease that increases load on the facet joints
Symptoms
- Aching or sharp pain in the mid-back, often near the spine
- Pain that worsens with twisting, extension, or prolonged standing or sitting
- Localized tenderness over the affected facet joints
- Referred pain that may radiate around the ribs or into the chest wall (not cardiac in origin)
- Stiffness or reduced mobility in the upper or mid-back
- Symptoms may mimic myofascial pain or be confused with thoracic disc disorders
Diagnosis
- Clinical examination reproducing pain with spinal extension or rotation
- Imaging studies:
- X-rays to evaluate spinal alignment and facet joint space narrowing
- CT scan for detailed visualization of facet joint anatomy
- MRI to assess soft tissues and rule out disc pathology
- Diagnostic facet joint injections: Temporary relief with local anesthetic supports the diagnosis
Treatment
Conservative Management:
- NSAIDs or acetaminophen to reduce inflammation and pain
- Physical therapy focused on thoracic mobility, posture correction, and strengthening
- Postural training and ergonomic correction for work and daily activities
- Shockwave therapy
- Manual therapy including joint mobilization and soft tissue techniques
Interventional Options:
- Facet joint injections using corticosteroid and anesthetic
- Prolotherapy or PRP
- Medial branch nerve blocks
- Radiofrequency ablation (RFA) for longer-term pain relief
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