The atlanto axial articulation is a complex of three synovial joints, which join the atlas c1 to the axis c2. The c1c2 joint, also known as the atlanto axial aa joint, allows for cephalic rotation and is composed of three joints. We would like to comment first on the nomenclature of the joint as described in the article c1c2 intraarticular injection. Atlanto axial joint intraarticular injection has the potential for serious complications, so it is imperative to be familiar with the anatomy of the joint in relation to the surrounding vascular and neural structures. Chapter 15 atlantoaxial joint injections andrea trescot introduction the atlantooccipital ao and atlantoaxial aa joints are unique joints in the spine, connecting the cervical region to the base of the skull. Notes for parents and carers revised july 2001 3 downs syndrome association. Imaging of atlantooccipital and atlantoaxial traumatic. Occasionally, atlantoaxial pannus is reported when patients without a history of ra undergo magnetic resonance imaging mri of the cervical spine.
The atlantoaxial joint is one of the complex and important joint in the body. The analitical functional characteristics of the atlantoaxial joint are based on lack of the joint surfaces congruence. The vertebral artery lies lateral to the atlanto axial joint as it courses through the c2 and c1 foramina. There are several ways in which a subluxation can occur. Nondisplaced fracture or dislocation of atlanto axial joint results in severe pain, numbness and weakness in upper extremities. A case report of atlantoaxial instability in a down. In human volunteers, distending the lateral atlantoaxial joint with contrast agent produces occipital pain, and injection of local anesthetic into the joint relieves the headache 1, 2. The causes of aai are not well understood but may include abnormalities of the ligaments that maintain the integrity of the articulation, bony abnormalities of the cervical vertebrae, or both. Operator grasps the head with the palms of the hands and flexes the head to approximately 3045 operator introduces left rotation against the restricted barrier. Imaging of atlantooccipital and atlantoaxial traumatic injuries. Atlantoaxial subluxation radiology reference article. Objective pannus formation in the atlanto axial joint is a wellrecognized complication of rheumatoid arthritis ra. These mechanics are determined by the bone structures. The aa and ao joints are an often underappreciated cause of pain and should be part of the differential diagnosis of cervical spine pain.
Extension tubing is recommended for all lateral atlantoaxial joint injections to minimize movement of the needle tip once it has reached its appropriate target. Pannus formation in the atlantoaxial joint is a wellrecognized complication of rheumatoid arthritis ra. Jun 06, 2014 there are three joints connecting atlas and axis. A computed tomography ct scan confirmed a 45 rotatory subluxation of c1 on c2, with forward subluxation of the lateral mass of the atlas off the axis on the left and posterior subluxation on the right fig. Atlanto axial joint anatomy considers a most vital joint. Bogduk, adding to lance and anthonys contributions to the anatomic explanation for this syndrome, argued that proprioceptive fibers from the lingual nerve returning via the c2 ventral ramuscervical plexus are impacted against the edge of an articular process of the atlantoaxial joint. The lateral atlanto axial injections resulted in consistent referral patterns, whereas the atlanto occipital referral patterns varied significantly.
The vertebral artery is lateral to the atlantoaxial joint as it courses through the c2 and c1 foramina. The c1c2 joint, also known as the atlantoaxial aa joint, allows for cephalic rotation and is composed of three joints. The vertebral artery lies lateral to the atlantoaxial joint as it courses through the c2 and c1 foramina. The joint capsules of the atlanto occipital and atlantoaxial axial joints stabilize the ccj. A tentative composite diagram of the experimentally induced pain was created for each joint.
Morphology and kinematics of the atlantoaxial joints and their. The sensory nucleus of the nerve that supplies the jaw joint and sinuses, the largest of the cranial nerves is located in the upper neck. The mechanical properties of the atlantooccipital joint are mostly flexion and extension with minimal involvement in axial rotation. It is usually secondary to trauma, infection tuberculous and nontuberculous atlas and axis and rheumatoid arthritis. Atlantooccipital and lateral atlantoaxial joint pain. Most patients are female 74% presenting with a unilateral arthritis 76% head rotation is usually markedly reduced. Among the ligaments that connect the atlas to the axis, the anterior and posterior atlantoaxial ligaments are. The mechanical properties of the atlanto occipital joint are mostly flexion and extension with minimal involvement in axial rotation. Lateral aa joints are synovial and therefore are subject to inflammatory and degenerative changes that may result in cervicogenic headaches, neck pain, and decreased range of motion or altered.
Atlanto axial dislocations in the absence of trauma, disease of the bone or congenital anomalies,1 although occurring almost exclusively in children, have received little attention from pediatricians. Atlantoaxial instability among people with downs syndrome. It is also sometimes called the aa or the c12 joint. Atlantoaxial joint distraction as a treatment for basilar invagination. Atlanto axial subluxation is a rotational disorder of the atlanto axial joint, that results in either limited rotation of the neck, or, in rare cases, fixation. Patient age atlantoaxial joint facet joints right left lower spine 1 72 2 2 2. A widening of the atlantoaxial joint, as measured between the posterior surface of the anterior arch of atlas and the front of the odontoid process, indicates an injury to the transverse atlantal ligament. Joints connect the vertebrae, the bones of your spine. Atlantooccipital and lateral atlantoaxial joint pain patte.
An atlantoaxial aa joint injection is an outpatient procedure for diagnosing and treating chronic upper neck pain and headache. The anterior facet of c1 is fixed on the facet of c2. Among the ligaments that connect the atlas to the axis, the anterior and posterior atlanto axial ligaments are. Additionally, bogduk believed that the ipsilateral neck pain component of this syndrome is. The atlanto axial joint is composed of two lateral joints between the superior facets of the axis and inferior facets of the atlas and a median joint between the dens of the axis and the anterior arch and transverse ligament of atlas. In a nontraumatic setting flexion and extension views may be performed. Peak age distribution occurs between 50 and 69 years of age. Traumatic atlantoaxial rotatory subluxation emergency. Although the joint is between c1 and c2, most of the literature describes it as the lateral atlantoaxial aa joint rather than c1c2 zygapophysial or facet joint. Resolution of a periodontoid rheumatoid pannus mass in an elderly patient treated with a rigid cervical collar. In addition, the atlantoaxial joint plays a key role in the development of cervicogenic headaches, and research shows that upper cervical mobilization can. It may be associated with dislocation of the lateral mass of c1 on c2. The atlantoaxial joints can lose stable articulation from traumatic.
The joint capsules of the atlantooccipital and atlantoaxial axial joints stabilize the ccj. If the transverse ligament that maintains the position of the odontoid process relative to c1 is torn, c1 will translate forwards on c2 in flexion. Atlantoaxial instability screening information sheet. Atlantoaxial joint intraarticular injection has the potential for serious complications, so it is crucial to be familiar with the anatomy of the joint in relation to the surrounding vascular and neural structures fig.
Nondisplaced fracture or dislocation of atlantoaxial joint results in severe pain, numbness and weakness in upper extremities. The uppermost cervical vertebra the atlas rotates about the odontoid process of the second cervical vertebra the axis. Ogoke, the management of the atlantooccipital and atlantoaxial joint pain, pain physician, vol. New atlantooccipital c0c1 joint injection technique. Plane joint between inferior facets of atlas and superior facets of axis. It can occur with or without c1c2 dislocation 6, 7.
Atlanto axial subluxation is a disorder of c1c2 causing impairment in rotation of the neck. Atlantoaxial dislocations in the absence of trauma, disease of the bone or congenital anomalies, 1 although occurring almost exclusively in children, have received little attention from pediatricians. The joint connecting the first cervical vertebra atlas or c1 with the second cervical vertebra is called the atlanto axial joint. Atlantoaxial instability aai is a condition that affects the bones in the upper spine or neck under the base of the skull. This results in excessive movement of this joint instability which can cause neck pain and pressure on the nerves of the spinal cord which runs through the tunnel vertebral canal created by the vertebrae. The atlantoaxial joint is mostly responsible for axial. Atlantoaxial dislocation, atlantoaxial joint, atlas, axis, basilar.
Oct 25, 2014 this is a presentation on atlanto axial and atlanto occipital joints. The atlanto axial joint is one of the complex and important joint in the body. Degeneration of the atlantoaxial joints a histological study of 9 cases ulrich berlemann1, ralph laubli1 and robert j moore2 1department of orthopaedic surgery, spine service, inselspital, university of berne, freiburgstrasse, ch3010 berne, switzerland, 2institute of medical and veterinary science, adelaide, south australia. Atlantoaxial joint definition of atlantoaxial joint by. Atlantoaxial is listed in the worlds largest and most authoritative dictionary database of abbreviations and acronyms. Other uncommon causes reported include retropharyngeal abscess, malignant deposits, ankylosing spondylitis sorin, et al, 1979. As lesoes da coluna cervical sao frequentemente descritas como eventos catastroficos em. The analitical functional characteristics of the atlanto axial joint are based on lack of the joint surfaces congruence. Atlantoaxial joint intraarticular injection has the potential for serious complications, so it is imperative to be familiar with the anatomy of the joint in relation to the surrounding vascular and neural structures.
Assesses the integrity of the atlanto axial joint and more notably the stabilizers of the dens on the atlas. The atlanto axial joint allows 1015 o of flexionextension, 30 o of axial rotation and only minimal lateral flexion. Atlantoaxial joint an overview sciencedirect topics. A search of the medical literature resulted in our finding records of twentytwo cases. The atlantoaxial joint allows complex movements of the cervical spine while. The atlantoaxial joint is composed of two lateral joints between the superior facets of the axis and inferior facets of the atlas and a median joint between the dens of the axis and the anterior arch and transverse ligament of atlas. The middle or median joint is classified as a pivot joint and the lateral joints are plane articulations. It is a pivot joint the atlantoaxial joint is of a complicated nature. Pdf rheumatoid arthritis ra causes persistent synovitis which could lead to bone erosion, loss of joint cartilage and loose of ligament. The atlantoaxial joint allows 1015 o of flexionextension, 30 o of axial rotation and only minimal lateral flexion. Subluxation of the atlantoaxial joint occurs when the normal alignment of the first and second vertebrae in the neck is disrupted. The atlantoaxial joint is the most mobile portion of the spine, predominantly relying on the ligamentous framework for stability at that level. We have described a distinctive clinical syndrome which results from clc2 facet joint oa 6. Patient is supine on the table with the operator sitting or standing at the head.
The atlantoaxial joint is a joint in the upper part of the neck between the first and second cervical vertebrae. Feb 12, 2017 chapter 15 atlanto axial joint injections andrea trescot introduction the atlanto occipital ao and atlanto axial aa joints are unique joints in the spine, connecting the cervical region to the base of the skull. The atlanto axial joint anatomy, the jaw joint and the sinuses are intimately interconnected. The atlanto axial joint is a joint between the first and second cervical vertebrae. Several different image modalities are available for use in aa joint blocks.
Under the condition of the horizontal equilibrium of the first cervical vertebra, the contact between the atlases and the axes occurs only at the top of the joint which results in rising the joint angles. Atlantoaxial subluxation is a rotational disorder of the atlantoaxial joint, that results in either limited rotation of the neck, or, in rare cases, fixation. The lateral masses articulate superiorly with the occipital condyles and inferiorly with c2, forming the atlantooccipital and atlantoaxial joints, teaching points the main role of mr imaging in evaluating the traumatic cer vical spine is to detect softtissue injury, especially to exclude. It is a complex joint made up of three synovial joints and constitutes the most mobile articulation of the spine. Half of the total rotation in the neck comes from this joint. There are two lateral atlantoaxial joints which are concave in an anterior posterior direction, this allows rotation. The anterior facet of c1 becomes locked on the facet of c2, causing impaired rotation at this joint.
A contralateral oblique view with cephalad tilt showing anatomic landmarks and needle in position. Normally, this atlanto dental distance is less than 2 mm, sometimes a maximum of 3 mm is accepted in men and 2. Atlantoaxial articulation radiology reference article. The median atlantoaxial joint is the articulation of. Lateral aa joints are synovial and therefore are subject to inflammatory and degenerative changes that may result in cervicogenic headaches, neck pain, and decreased range of motion or altered sensation. Atlantoaxial pannus in patients with and without rheumatoid.
The present study was designed to determine the frequency of. Because of the complicated anatomic landscape, imaging guidance is vital in addition to a sound understanding of the anatomy. B lateral view showing a 25gauge needle inserted high in the joint. Plain x rays showed abnormality at the atlantoaxial joint fig 1. Rotatory atlantoaxial dislocation associated with ossiculum terminale and mongolism. Atlantoaxial osteoarthritis aaoa can cause severe occipital neck pain as documented in the literature 5, 11, 12, 17.
Anatomic considerations for injection of the lateral. A widening of the atlanto axial joint, as measured between the posterior surface of the anterior arch of atlas and the front of the odontoid process, indicates an injury to the transverse atlantal ligament. Pannus formation in the atlanto axial joint is a wellrecognized complication of rheumatoid arthritis ra. The radiological appearances of the atlantoaxial joint are classified in three types, lateral atlantoaxial, atlantoodontoid and mixed. The partners healthcare research patient data registry was freetext. Atlantoaxial and occipital joint linkedin slideshare. The joint between the upper spine and base of the skull is called the atlantoaxial joint.
Objective pannus formation in the atlantoaxial joint is a wellrecognized complication of rheumatoid arthritis ra. Zygapophysial joints are described from c2c3 and below. Mechanical stabilization the major stabilizers of the atlantoaxial joint are the transverse ligament, which allows axial. Ligaments and tendons supports atlanto axial joint. You may feel pain if your atlanto axial joint is injured. Dexamethasone should not be mixed with ropivacaine because of the risk of precipitating the steroid so it acts as a particulate. In human volunteers, distending the lateral atlanto axial joint with contrast agent produces occipital pain, and injection of local anesthetic into the joint relieves the headache 1, 2. Conclusion this study confirms the nociceptive ability of these cervical synovial joints. Looking for online definition of atlantoaxial or what atlantoaxial stands for. The joint between the axis and atlas is a pivot type of joint that allows the head turn. Atlantoaxial subluxation is a disorder of c1c2 causing impairment in rotation of the neck. The atlantoaxial articulation is a complex of three synovial joints, which join the atlas c1 to the axis c2. The atlantoaxial joint stabilizes the neck during activities and at rest.
Normally, this atlantodental distance is less than 2 mm, sometimes a maximum of 3 mm is accepted in men and 2. Occasionally, atlanto axial pannus is reported when patients without a history of ra undergo magnetic resonance imaging mri of the cervical spine. Pdf on dec 4, 2017, gergely bodon and others published the atlantooccipital joint. Rheumatoid arthritisatlantoaxial subluxation and its clinical presentation. When this joint gets locked up due to suboccipital or cervical tightness, capsular fibrosis, or arthritic changes, more demand is placed on the neck joints below during cervical rotation. Joint laxity resulting in unstable atlantooccipital and atlantoaxial jointswith an increased susceptibility to fatal cord injuriesis a recognized phenomenon in patients with. Atlantoaxial definition of atlantoaxial by medical. In its mildest form, aai is asymptomatic and is diagnosed using x. Methods the partners healthcare research patient data registry was freetext. The lateral atlantoaxial injections resulted in consistent referral patterns, whereas the atlantooccipital referral patterns varied significantly. Anatomic considerations for injection of the lateral atlanto. Atlanto axial dislocation is an uncommon condition. Atlanto axial joint anatomy considers a most vital joint in.