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Year : 2016  |  Volume : 2  |  Issue : 3  |  Page : 106-108

Atypical presentation of cervical facet arthropathy: Neck pain along with numbness and weakness of upper limb

1 Fellow, Daradia: The Pain Clinic, Kolkata, West Bengal, India
2 Director, Daradia: The Pain Clinic, Kolkata, West Bengal, India
3 Faculty, Daradia: The Pain Clinic, Kolkata, West Bengal, India

Correspondence Address:
Gautam Das
Director, Daradia: The Pain Clinic, Kolkata, West Bengal
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Source of Support: None, Conflict of Interest: None

DOI: 10.5005/jp-journals-10046-0054

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Most of the cervical facet arthropathy cases present with neck pain with referred pain in the head and upper extremities. Tenderness to palpation over the facet joints or paraspinal muscles, accentuation of pain with cervical extension or rotation, and the absence of any neurologic deficits are the usual findings. Radicular symptoms are seldom associated with cervical facet arthropathy. We report a case of a 23-year-old female patient presented with chief complaints of neck pain radiating to entire right upper limb with weakness and numbness of that limb. Physical examination revealed limitation of range of motion of neck, painful extension and lateral rotation of neck, tenderness over C4-5 and C5-6 facet joints, and tenderness over right trapezius muscle. Weakness and numbness over hand was also present, though electromyography and nerve conduction velocity study was normal in both upper limbs. Magnetic resonance imaging (MRI) cervical spine was suggestive of mild posterior disk osteophytes at C4-5, C5-6, and C6-7 causing grade 1 cervical canal stenosis and cervical spondylosis with degenerative disk disease. Trigger point injections were given in trapezius and scalene muscle. There was not much improvement. Considering facet arthropathy as a differential diagnosis, diagnostic median branch block at C4, C5, and C6 level was done. It was positive with more than 80% pain relief. Later on, radiofrequency (RF) ablation of C4, C5, and C6 median branch was done. Pain was reduced significantly with improvement of other symptoms like weakness and numbness.

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