Cervical spine dysfunction
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Cervical Spine Dysfunction. CRANIOFACIAL PAIN OF CERVICAL ORIGIN Recognize craniofacial pain of cervical origin Understand basic anatomy and physiology of the upper cervical spine Overview of craniovertebral testing and treatment. Occipital/supraorbital syndrome (C1).

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  • CRANIOFACIAL PAIN OF CERVICAL ORIGIN

    • Recognize craniofacial pain of cervical origin

    • Understand basic anatomy and physiology of the upper cervical spine

    • Overview of craniovertebral testing and treatment


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Occipital/supraorbital syndrome (C1)

OA unilateral lesion, unilateral pain, retroorbital nausea


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Arnold’s neuralgia - Greater Occipital Nerve Impingement (C2)

Unilateral Pain from posterior rami C2, sharp shooting attacks of pain, pain at posterior neck to vertex, pain at retromastoid region


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Otic Syndrome- Ventral Rami C2-lesser occipital nerve and greater auricular nerve

Pain, buzzing, vertigo symptoms related to ears without ear pathology


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Auriculomandibular Neuralgia - C3 greater auricular nerve

Pain corresponds to C3, occipital headache, pain radiating to auricular lobe and angle of mandible, generally unilateral


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Facet Joint Referred Pain Patterns greater auricular nerve

C2 - C3 and C3 - C4 refer pain into head


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The cervical spine connection greater auricular nerve

Trigeminal system and C1-C3 nerves along with CN VII, IX,X

Pain fibers descending from the brain stem converge in the posterior horn of the upper cervical spine. This convergence gives an anatomical basis for pain referral from the neck to the head.


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A Single Combined Nucleus-Trigeminocervical Nucleus greater auricular nerve

“terminals of the trigeminal nerve and the upper three cervical nerves ramify in a continuous column of grey matter formed by the par caudalis of the spinal nucleus of the trigeminal nerve and dorsal horns of the upper three cervical segments”

Bogduk, 1995

Kraus, 1988


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Transmits PAIN greater auricular nerve

Nociceptive information from cervical spine tissues is transmitted to the trigeminocervical nucleus, which in turn gives the patient the perception of symptoms in the head, face and jaw area.


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  • Cervicogenic Headache greater auricular nerve

  • pain sensitive structures in the neck

  • pathological processes or physiologic dysfunctions within the neck

  • ipsilateral pain and stiffness

  • decreased cervical ROM

  • tenderness at cervical facets

  • pain elicited with active or passive exam of the neck


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Basic Cervical ROM greater auricular nerve


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CO - C1 - C2 greater auricular nerve


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Suboccipital Triangle greater auricular nerve

  • Superior Oblique – occiput to TP C1

  • Inferior Oblique – TP C1 to C2

  • Rectus Capitus Post Major – occiput to

    spinous process C2


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Greater Occipital Nerve greater auricular nerve

  • Between C1 and C2

  • Emerges under inferior oblique

  • At semispinalis

  • At upper trapezius


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The Atlas greater auricular nerve- ring shaped without vertebral body- articulates with occipital condyles and axis


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The Axis greater auricular nerve

  • Pacifier shaped

  • Convex shoulder of axis are built to allow rotation


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Upper Cervical Spine AA Testing greater auricular nerve


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OA Testing greater auricular nerve

  • Occipital / Atlas Testing (OA)

  • Imbalance of the occiput as it meets the first vertebrae (C1) can create head and facial pani.

  • Testing and treatment to the occiput(O) and atlas (A) complex can help eliminate pain.


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PHYSICAL THERAPY greater auricular nerve

  • MANUAL THERAPY – to correct the upper cervical alignment and restore normal biomechanics of the upper cervical spine and restore the normal lordosis or arch to the neck

  • Neuromuscular Reeducation Exercise to balance the craniocervical, craniomandibular, and the scapulothoracic systems.

  • Mechanical Home Cervical Traction Set Up


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“Live life at ease.” greater auricular nerve

  • Call 216-682-0413for your comprehensive craniomandibular cervical evaluation and treatment.


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