Role of patient history and physical examination to diagnose chronic low back pain originating from the facet joints.

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Role of patient history and physical examination to diagnose chronic low back pain originating from the facet joints.

Facet joints or joints with “small faces” provide the joint about 20% of the torsional stability in the neck and low back. These joints  can be found at every spinal level. The vertebrae of the chest area permit a small amount of forward/backward and some side bending with very little twisting. The facet joints are paired diarthrodial articulations between the posterior elements of the adjacent vertebrae. Facet joint motion can be disturbed by trauma or injury. Stiffness in the joint restricting motion is called as hypomobility, while excessive joint motion is known as hypermobility.

Mass E T and colleagues conducted a systematic review in which the patient history and physical examination were frequently used to diagnose chronic low back pain (CLBP) originating from the facet joints. The aim of the systemic review was to determine the diagnostic accuracy of patient's examination to identify the CLBP originating from the facet joints using diagnostic blocks as reference standard. For the data collection, MEDLINE, EMBASE, CINAHL, Web of Science and the Cochrane Collaboration database from inception were used and data published till June 2016 was searched.

In this review, two review authors independently selected the studies for inclusion, extracted data and assessed the risk of bias. Sensitivity and specificity values with 95% of confidence intervals (CI) were calculated. Total 12 studies were included in which 129 combinations of index tests and reference standards were presented. Most of these index tests have only been evaluated in single studies with a high risk of bias. Four studies were evaluated to assess the diagnostic accuracy of the Revel's criteria combination.

However, due to clinical heterogeneity, results were not pooled out. The published sensitivities ranged from 0.11 (95% CI, 0.02-0.29) to 1.00 (95% CI, 0.75-1.00) and the specifications were ranged from 0.66 to 0.91. Owing to clinical heterogeneity, the evidence for the diagnostic accuracy of patient history and/or physical examination to identify the facet joint pain is inconclusive. To conclude, patient history and physical examination cannot be used to limit the need of a diagnostic block. The validity of the diagnostic facet joint block should be further studied and high quality studies are still required to confirm the results of single studies. 

Source:

Eur J Pain. 2016 Oct 10

Link to the source:

https://www.ncbi.nlm.nih.gov/pubmed/27723170

Original title of article:

Systematic review of patient history and physical examination to diagnose chronic low back pain originating from the facet joints.

Authors:

Maas ET1, Juch JN2, Ostelo RW3,4, Groeneweg JG2, Kallewaard JW5, Koes BW6, Verhagen AP6, Huygen FJ2, van Tulder MW

 

Eur J Pain. 2016 Oct 10
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