Locking in the upper back and pain on breathing: a facet joint problem

Facet joints are small joints at the back of the vertebrae that guide movement. There is a pair at each vertebral level, with joint surfaces covered by a thin membrane.

A sudden twist, staying in one position for long, or a strain noticed on waking can irritate them. After irritation, surrounding muscles contract reflexively and movement becomes restricted.

Patients usually describe this as 'locking'. Turning in a particular direction or breathing deeply produces sharp pain, and movement in that direction all but stops.

Pain is usually felt on one side of the spine, at a point limited enough to be indicated with a finger. That 'point' quality separates it from diffuse muscular pain.

Deep breathing, coughing and turning the trunk toward the affected side sharpen the pain. That increase often leads patients to worry about a lung or heart problem.

Pressing on that point reproduces the patient's familiar pain. This is the most practical examination sign supporting the diagnosis.

Pain increasing with breathing suggests pulmonary causes. Where there is fever, breathlessness or sudden diffuse chest pain, those must be excluded first.

Rib joint problems produce a very similar picture and the two often coexist. They are distinguished on examination, and the treatment approach is largely shared.

In thoracic disc herniation, pain radiates around the ribs like a band and can come with sensory change. Facet pain is point-like with limited radiation.