Damage to the facet joints between the second and third cervical vertebrae can cause referred headaches. Damage to the joints between the fifth and sixth vertebrae are usually responsible for neck pain, arm pain and pain between the shoulder blades. Cervical facet joint pain is typically a unilateral (one-sided), dull and aching neck pain with referral into the back of the neck and between the shoulder blades.

Shortly after the accident, neck pain may be minimal with an onset of symptoms during the subsequent 12 – 72 hours. If the damage also caused disruption of the intervertebral disc, then there could be compression of a nerve root and radicular pain (nerve root pain) that may extend down the whole length of the arm.

Some patients experience dizziness which may result from injury to facet joints that are supplied with balance receptors (proprioceptors) which can cause confused feedback to the midbrain and brainstem, where balance is controlled.

There is a grading system that is used to define the seriousness of the injury.

• Grade 0 – No neck pain complaints, no physical signs.
• Grade 1 – Neck pain complaints, stiffness and/or tenderness, but no other physical signs.
• Grade 2 – Neck pain complaints and musculoskeletal signs (decreased range of motion and point tenderness).
• Grade 3 – Neck pain complaints and neurologic signs (weakness, sensory and reflex changes).
• Grade 4 – Neck pain complaints with fracture and/or dislocation.

How is it diagnosed?

A clinical examination by your specialist or therapist will allow for a reasonable suspicion, but a CT scan and radio isotope scan (see the section Tests and Scans) will help make the diagnosis. The CT scan will give information about the anatomy of the joints and the radio isotope scan will reveal any inflammation in the joints. Tests can, however, only give an indication and should be interpreted along with the clinical picture.

How is it treated?

The available treatment includes anti-inflammatory medication, analgesics, physiotherapy and other manual treatments such as chiropractic treatment, pressure point therapy, massage therapy, traction and other therapies. Rhizotomies can be very successful in the management of whiplash injuries (see the section Cervical Radiofrequency Rhizotomy).

Does this treatment have any complications?

The only real complication is the fact that this condition is difficult to treat and treatment is not always successful. There have been reports that overzealous chiropractic treatment of the neck can have complications, but modern chiropractic techniques are much better tolerated.

What are the long-term expectations?

In cases where the symptoms settle with conservative measures, the symptoms may reappear at some stage. This is a condition with ongoing morbidity and treatment has to be ongoing. In some cases symptoms are resistant to all treatment and this can be a challenging situation to manage.