Cervical facet pain

When neck pain stays near the spine or refers into the shoulder blade without a clear nerve-root pattern, the small joints at the back of the neck (the facet joints) are often part of the story.

What it feels like

People often describe a deep ache at the base of the skull or along one side of the neck, sometimes with stiffness that makes looking over the shoulder feel like work.

Pain may travel into the shoulder girdle or the upper back, but it usually does not shoot all the way into the fingers the way a pinched nerve can.

Extension and rotation (looking up or turning) often aggravate it. Supported flexion or resting the head can feel better for a while.

What is going on

The cervical facet joints are paired joints behind each disc level. They guide motion and can develop arthritis, inflammation, or mechanical irritation with age, posture load, or prior injury.

Those joints send pain through the medial branch nerves. That is why a carefully placed medial branch block can help confirm whether the facets are driving the pain.

Imaging may show facet arthropathy, but pictures alone do not diagnose the pain source. The history and exam still matter most.

How we evaluate

We start with where the pain sits, what movements provoke it, and whether there are arm symptoms that suggest a nerve root instead.

A focused cervical exam looks at range of motion, tenderness, and neurologic findings. Existing imaging is reviewed when you have it; we order more only when it changes the plan.

If the pattern looks facet-mediated, we may discuss a diagnostic medial branch block as a next step rather than guessing.

What we may offer

Care often begins with activity guidance and coordinated physical therapy when that fits.

When the exam points to the facets, medial branch blocks can clarify the diagnosis and, when positive, may lead to a discussion of radiofrequency ablation on the same pathway.

If arm pain or neurologic symptoms dominate, we look toward radicular pathways and may discuss epidural steroid injections instead.

Is cervical facet pain the same as a pinched nerve?

Not usually. Facet pain tends to stay closer to the neck and shoulder blade. A pinched nerve more often sends shooting pain, numbness, or tingling into the arm or hand in a nerve-root pattern.

Will an MRI tell us if my facets are the problem?

MRI can show facet changes, but many people have those findings without matching pain. We use imaging as context and rely on the story, exam, and sometimes a diagnostic block.

What is a medial branch block for the neck?

It is a short diagnostic injection that numbs the nerves supplying specific cervical facet joints. If your usual pain settles during that window, those joints are likely contributing.