Cervical microarthrosis is very common in clinical practice, and many previously less well-defined neck, occipital, and shoulder pains are due to this condition. I personally know that many people only receive physical therapy such as massage, and few go on to receive further injections and radiofrequency therapy, which is still necessary if symptoms are severe. Clinical syndrome Cervical microarticular syndrome is a general term for a group of symptoms that include pain in the neck, head, shoulders, and adjacent upper extremities in areas that do not correspond to the distribution of the neuropil. This pain is dull and not well defined. The pain can be unilateral or bilateral and is thought to be caused by a small joint lesion. Pain in cervical subtalar syndrome can be exacerbated by flexion, extension, or lateral flexion of the cervical spine. Patients often experience increased pain in the morning after activity. Each small joint receives innervation from two segments; from the corresponding segment and from the dorsal branch fibers of the preceding segment. This pattern explains why this pain of small joint origin is not so well defined and why a block of the dorsal root nerve of the previous segment is also required to obtain better pain relief. Signs and Symptoms Most patients with cervical microarticular syndrome will have deep pressure pain in the paracervical muscles and will also have muscle spasm. Patients often present with limited range of motion of the cervical spine and may experience pain during anterior flexion, extension, lateral flexion, and rotation of the cervical spine. In the absence of coexisting radiculopathy, plexopathy, or nerve entrapment, cervical microarthrosis does not usually present with motor or sensory deficits. Examination Almost all people in their fifties will show small joint abnormalities on cervical spine radiographs. The significance of these findings was debated among many pain specialists for a long time, until CT and MRI became available to clarify the relationship of abnormal small joints to cervical nerve roots and other structures. MRI should be performed in all patients with suspected cervical microarticular syndrome. However, all imaging tests can only make a suspicious diagnosis, and a diagnostic injection treatment is necessary to further determine which small joint is causing the pain. If the diagnosis of cervical microarticular syndrome is in doubt, laboratory tests are needed to rule out other diseases causing the pain, including routine blood work, sedimentation, antinuclear antibodies, HLA-B27 antigen, and biochemistry. The differential diagnosis of cervical microarthrosis is a diagnosis of exclusion that requires a combination of history, physical examination, imaging, and diagnostic injections. Conditions with symptoms similar to cervical microarthrosis syndrome include soft tissue pain in the neck, cervical bursitis, cervical fibromyositis, arthritis, and cervical nerve dysfunction. Treatment Treatment of cervical microarthrosis is best achieved by combining multiple modalities. Physical therapy such as hot compresses, massage, and muscle relaxation combined with NSAIDs are reasonable starting treatments. The next logical treatment step is a cervical subtalar joint block. Injection therapy with local anesthetic drugs plus hormones in the dorsal branch of the medial branch and in the small joints is very effective in relieving symptoms. Radiofrequency therapy is a good option for patients who have experienced significant relief of symptoms after receiving injections, but the effect is not sustainable. Tricyclic antidepressants are best used for patients with sleep disorders and depression. Small cervical joint blocks are often used in combination with atlanto-occipital blocks to treat pain. Although the atlanto-occipital joint is not really a small joint anatomically, the technique is similar to that of a subtotal joint block. Complications and risks Because of the proximity of the cervical subtotal joint to the spinal cord and traveling nerve roots, only physicians who are familiar with the local anatomy and experienced in pain intervention techniques should perform operations in this area. The proximity to the vertebral artery, combined with the vascularity of this region itself, leads to an increased chance of intravascular injections, and just a small amount of local anesthetic entering the vertebral artery can lead to seizures. Although not far from the brain and brainstem, ataxia due to the upward movement of local anesthetic medication from a cervical subtotal joint block is very rare. Many patients feel a transient headache and increased neck pass following cervical subtotal joint injection therapy. Clinical Experience Cervical subtotal joint syndrome is a common cause of pain in the neck, occiput, shoulder, and upper extremity. It is often confused with soft tissue pain in the neck and with cervical fibromyositis. Diagnostic small intra-articular injections can help confirm the diagnosis. Clinicians must be careful to rule out other cervical medullary disorders, such as spinal cavernous disease, which can present with similar symptoms in the early stages. Compulsive spondylitis can also present with symptoms similar to those of cervical microarticular syndrome, and care must be taken to differentiate to avoid further joint damage as well as dysfunction. Many pain specialists believe that cervical subtalar and atlanto-occipital joint injections should be considered for fall and whiplash injuries and cervicogenic headaches whenever cervical epidural injections and occipital nerve injections are ineffective in relieving head and neck pain.