Chernoff MD - Orthopedic & Spinal Surgery

Facet Joint Syndrome & Piriformus Syndrome

Facet Joint Syndrome

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Facet joint syndrome is a condition that occurs when the facet joints of the spine become damaged or worn out. The facet joints are the small joints located between the bones of the spine; they are lined with cartilage and synovial fluid that allows them to glide easily over each other. They are also intertwined with nerves that run from the spinal cord to the arms, legs and other parts of the body. The facet joints are in constant motion and provide the spine with flexibility that allows movement, and stability that keeps the back from moving too far forward or twisting too far.

Due to constant motion, the facet joints may wear out or degenerate, and the cartilage within the joints may thin or tear over time. This causes increased friction in between the individual vertebra. This may occur from arthritis, overuse or injury. As a result, the facet joints may become swollen or painful.

The symptoms of facet joint syndrome vary depending on where the affected joint is located, and what nerve roots it affects. If the affected joints are in the neck, they may cause headaches and difficulty in moving the head and neck. If the degenerated joints are in the back, they may cause pain or stiffness in the lower back, buttocks or thighs. Inflamed facet joints may also cause painful muscle spasms.


Facet joint syndrome is diagnosed after a physical examination and review of symptoms. An MRI scan may be performed to provide internal images of the back and spine. A diagnostic facet injection is also used to confirm a diagnosis of facet joint syndrome. Diagnostic facet injections contain a corticosteroid, and an anesthetic to temporarily relieve discomfort. If the patient experiences relief, the facet joint is likely the cause of the pain.

Initial treatment for facet joint syndrome is often conservative and may include rest, and ice or heat therapy. Other conservative approaches may include:

  • Anti-inflammatory drugs
  • Physical therapy
  • Use of a back or neck brace

If symptoms are troubling, pain medication may be prescribed. Steroids injections directly into the facet joints may also help to relieve pain for an extended period of time. In severe cases, surgery may be required to clean out the facet joints and deaden symptomatic local nerves.

Piriformis Syndrome

Piriformis syndrome occurs when the piriformis muscle, which runs from the lower spine to the top of the thigh bone, presses on the sciatic nerve. As a result, it causes pain, tingling and numbness in the buttocks and, often, down the back of the leg. The pain often worsens as a result of sitting for a long period of time, walking, running, or climbing stairs. While piriformis syndrome may occur for no apparent reason or develop after regular physical activity, it is sometimes caused by a a traumatic injury, such as a car accident or a fall.

People with piriformis syndrome often experience tenderness in the buttocks and pain down the back of the thigh, calf and foot. It may start as intense, burning pain in the buttocks and get worse during activities, such as walking or running, that cause the piriformis muscle to press against the sciatic nerve. Symptoms of piriformis syndrome may be long-lasting, often troubling patients for years.

Piriformis syndrome is diagnosed through a physical examination and a review of symptoms. The affected leg may be moved in several different positions to measure pain levels. Additional tests may include MRI or CT scans.

Treatment for piriformis syndrome may initially focus on exercises to stretch the piriformis muscle, and conservative treatments such as hot and cold therapy, massage, and taking a break from activities that may cause pain. Nonsteroidal anti-inflammatory medication may be used for pain relief. If discomfort persists, steroid injections into the piriformis muscle and the sciatic nerve may help to relieve pain. In severe cases, surgery may be necessary to relieve pressure on the sciatic nerve.

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