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. Symptoms and signs Most patients with cervical microarticular syndrome have deep pressure pain in the paracervical muscles and also muscle spasm. Patients often present with limited range of motion of the cervical spine and pain during forward flexion, extension, lateral flexion, and rotation of the cervical spine. Cervical microarticular syndrome does not usually have motor or sensory deficits. In C1-2 microarticular involvement, pain radiates to the back of the ear and occiput. In C2-3, the pain radiates to the forehead and eyes. C3-4 pain from the small joints radiates upward to the inferior occipital region and downward to the posterior lateral aspect of the neck. Pain from the C4-5 small joints may disperse to the base of the neck. C5-6 pain in the small joints may spread to the shoulder and interscapular region. Pain from C6-7 may spread to the supraspinatus and infraspinatus fossae. Adjunctive examinations Almost all individuals in their fifties will show small joint abnormalities on cervical spine radiographs. MRI should be performed in all patients with suspected cervical microarticular syndrome. However, all imaging examinations 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. The dorsal branch of the medial branch and the injection of local anesthetic drugs plus hormones into the small joints are very effective in relieving symptoms. Cervical subtotal 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.