Determining The Cause Of Your Neck Pain

If you are reading this article, I am going to assume you have neck pain. That is a pain starting in your neck and radiating into the base of your neck and shoulders. There are a lot of different causes of neck pain, but people with neck pain can be sorted into two buckets. What we are going to figure out is if your pain is more likely coming from your facet joints (arthritis), or whether you have a cervical disc herniation with radiculopathy, or both.

Why should you care? Because finding the right solution depends on solving the correct problem. The treatment for neck pain due to facet joint pain caused by arthritis (spinal manipulation or therapy with non-steroidal anti-inflammatory drugs followed by radiofrequency ablation if those fail), is different than the treatment for cervical disc herniation with radiculopathy (rest, non-steroidal, epidural injection, followed by ACDF surgery if those fail).

To help you figure out whether your pain is coming from your facet joints or a herniated cervical disc causing radiculopathy you need to answer four questions. To answer those four questions correctly, you need to understand two things about the condition and terminology. So, let’s start with those two things.

Thing 1: Neck pain from facet joints and cervical radiculopathy are similar but there are important differences

People often think that pain radiates from the spine out to the shoulder it must be coming from a nerve root and not a joint. This is not true. Neck pain caused by arthritis of the facet joints radiates into the base of the neck and shoulder as well. Interestingly, the level of the painful neck joint often predicts where the pain radiates. Check out this picture:

Neck pain due to facet joints is mostly (more than 80%) in the neck, and it radiates out to the base of the neck or shoulder when you move. Neck pain due to facet joint and neck pain due to nerve roots apart. Consider the following.

Second of two: cervical disc herniation is a result of a torn annulus and inflammation and/or direct compression of a herniated disc on a nerve root.

Nerve root problems produce pain and weakness in the muscles innervated by the nerve root, as well as numbness in the patch of skin that root covers.

OK. Now get a piece of paper and something to write with. I need you to write down the answers to these three questions:

Question 1/4: What does the pain that goes into your arm feel like?

Ignore the pain at the base of your neck, that means your shoulder, triceps, biceps, forearm, or all the way into your hand. If it is more like an ache, write FACET. If it is more like electricity start in your neck and shoots into the muscle, the write ROOT.

Question 2/4: Are you numb?

You need a friend for this part of the quiz. Test light touch or pin prick where you have the pain. If you are numb to light touch or pin prick in any of these areas write down ROOT and the level (C5, C6, C7, or C8):

· C5: top of your shoulder (deltoid),

· C6: space between thumb and pointer

· C7: middle and ring fingers,

· C8: outer pinky.

If you were NOT numb in any of these areas then write down FACET.

Question 3/4: Are you weak?

· C5: Chicken wing, Deltoid

· C6: resist rotating your wrist in a hand shake, Brachioradialis

· C7: Bend your fingers backward

· C8: hold your fingers together

If you were weak anywhere write down ROOT and the level. If you were not weak write down FACET.

4/4, Last question: what does your imaging show?

Start with your MRI (Magnetic Resonance Imaging) Look at the report. If there is mention of moderate or severe foraminal narrowing, moderate or severe nerve root compression, or herniated disc write ROOT. If none of those are mentioned write FACET.

What about your x-ray? If you had an x-ray was there any mention of arthritis in the report? If there is moderate, severe, marked arthritis then write FACET. Otherwise write root.

Time for the answer

First, what to do if you cannot figure this out. Call us.

Drumroll please: look at your results.


If they are all FACET, then you most likely have arthritis. The usual treatment for cervical arthritis is refractory to conservative measures if radiofrequency ablation. The details of the medial branch block test and treatment are on our website.

Listen to Larry: My dad is an attorney. He always told me a lawyer who represents himself has a fool for a client. His boy is a doctor. I would say anyone who is their own internet doctor has a fool for a patient. Don’t fool around with this stuff. See a doctor: