Studies examining history (including referral patterns) and physical examination signs for patients with cervical facetogenic pain
| Author, year | Patients | Design | Results | Comments |
| Dwyer et al 199077 | 4 asymptomatic volunteers and 1 patient with neck pain whose cervical facet joint capsules were ‘stimulated’ using 1 mL IA contrast | Prospective cohort study | Pain referral maps produced for C2–3 (lower head, upper neck), C3–4 (upper neck), C4–5 (well localized to mid-neck below C3–4), C5–6 (top of scapula and shoulder above the scapular spine) and C6–7 (lower neck to inferior angle of scapula) joints | Pain produced by injection in 9 out of 11 joints |
| Aprill et al 199013 | 10 pts with neck pain received MBB with LA and steroid | Prospective cohort study | Concordance between painful joint level(s) predicted based on clinical evaluation and response to diagnostic blocks | 4 pts had undergone anterior cervical fusions. 3 pts had negative discography results for cervical discogenic pain |
| Barnsley and Bogduk, 199376 | 16 pts with chronic neck pain, with or without referred pain in the head or shoulder after MVC, received controlled MBB with LA | Prospective study | 11 of 16 pts had complete relief of neck pain with restoration of neck movements after cervical MBB; 4 of the remaining 5 pts had a positive cervical MBB at non-predicted levels | No control group. Levels for cervical MBB chosen based on pain maps and sites of maximal tenderness. No patient had radiculopathy. Normal imaging studies. The 25 MBB performed were highly specific |
| Lord et al 199475 | 100 pts with chronic neck pain after whiplash received double diagnostic MBB with LA | Prospective study | C2–3 joint was responsible for headaches in 27% of pts confirmed by diagnostic TON block. Tenderness over C2–3 joint on examination predicted positive block | No control group. C2–3 joint responsible for headaches in 53% of pts when headache was main symptom |
| Lord et al 199668 | 24 pts with chronic neck pain after MVC with Quebec Task Force WAD grade I–IV selected by double diagnostic MBB with LA and placebo injection who underwent medial branch RFA | Prospective RCT | 44% of screened pts had headache and neck pain from cervical facet joints | Sham medial branch RFA group included C2–3 facet joint pain in 33% of pts |
| Fukui et al 199651 | 61 pts with neck pain from the cervical facet joints confirmed by IA capsular stimulation or electrical stimulation of dorsal rami C3–7 | Prospective cohort study | Pain region and source (joint and/or DR): Occipital region: C2–3 and C3 DR Upper posterolateral cervical region: C0–1, C1–2, and C2–3 Upper posterior cervical region: C2–3, C3–4, and C3 DR Middle posterior cervical region: C3–4, C4–5, and C4 DR Lower posterior cervical region: C4–5, C5–6, C4, and C5 DR Suprascapular region: C4–5, C5–6, and C4 DR Superior angle of scapula: C6–7, C6, and C7 DR Mid-scapular region: C7/Tl and C7 DR | |
| Jull et al 1998413 | 20 pts with neck pain who had complete pain relief with dual MBB. Assessed the diagnostic accuracy of physical examination | Observational study | 15 of 15 (100%) pts with cervical MBB-proven facet joint pain (and no CMBB-negative pts) were correctly identified based on physical examination. The correct segmental level was identified in all pts | Internal controls were asymptomatic joints. 100% sensitivity and specificity of physical examination to predict block response. Incidence of cervical facet joints as the cause of neck pain was 75% |
| Cooper et al 200749 | 194 pts with neck pain who underwent dual comparative MBB | Prospective observational study | Segmental patterns of pain arising from cervical facet joints identified: Suboccipital: C1–2, C2–3 Posterolateral neck: C3–4 Neck to shoulder girdle: C4–5 Lower neck to upper limb girdle: C5–6, C6–7 | Pain patterns of adjacent segments overlapped |
| Cohen et al 200720 | 92 pts who underwent cervical medial branch RFA | Retrospective study to determine factors associated with successful RFA | Paraspinal tenderness associated with successful outcome | Radiation of pain to head, opioid use, and pain exacerbated by neck extension and/or rotation associated with failure |
| King et al 200779 | 173 pts with suspected cervical facet joint pain based on physical examination studied with MBB | Observational study | Physical examination lacked validity, refuting results of a previous study with overlapping authors.413 Examination had a high sensitivity (88%) but low specificity (39%) | Pts with previous cervical spine surgery and those with negative physical examination signs were excluded |
| Smith et al 201373 | 90 subjects with WAD >6 months duration post-MVC who received IA injections and MBB; 30 healthy controls | Cross-sectional design comparing physical and psychological examination in responders and non-responders with WAD to control pts | 58 of 90 (64%) achieved at least 50% pain relief with IA or MBB. No difference in objective sensory testing, muscle activity or ROM between facet block responders and non-responders, but all were abnormal compared with controls. Facet non-responders had greater medication use and catastrophizing scores compared with responders | Large proportion of participants were lost to follow-up |
| Schneider et al 201480 | 125 pts with neck pain in whom a clinical examination protocol was validated against positive dual cervical MBB outcome (≥80% reduction of pain) | Prospective cohort study | A protocol consisting of MSE, PST, and ER test had a specificity of 84% (95% CI 77% to 90%) and a positive likelihood ratio of 4.94 (95% CI 2.8 to 8.2) for cervical facet joints being the source of neck pain | Sensitivity of PST and MSE were 94% (95% CI 90% to 98%) and 92% (95% CI 88% to 97%), respectively. Any single test was insufficient for diagnosis |
DR, dorsal ramus; ER, extension rotation; ITT, intention to treat; LA, local anesthetic; LR, likelihood ratio; MBB, medial branch block; MSE, manual spinal examination; MVC, motor vehicle collision; PP, per protocol; PST, palpation for segmental tenderness; pts, patients; QTF, Quebec Task Force; RFA, radiofrequency ablation; ROM, range of motion; TON, third occipital nerve; WAD, whiplash associated disorders.