Atlanto-occipital and lateral atlanto-axial joint pain patterns

Spine (Phila Pa 1976). 1994 May 15;19(10):1125-31. doi: 10.1097/00007632-199405001-00005.


Study design: Five asymptomatic subjects underwent provocative injections of the lateral atlanto-axial and atlanto-occipital joints.

Objectives: This study isolated and stimulated the lateral atlanto-axial and atlanto-occipital joints via fluoroscopically guided intra-articular injections to determine if they are potential pain generators. If they are pain generators, preliminary pain pattern maps will be constructed.

Summary of background data: The cervical zygapophyseal joints (C2-3 to C6-7) are potential pain generators as demonstrated by referred pain induced via isolated intra-articular joint injections in normal subjects. Tentative referral patterns based on direct mechanical stimulation of the lateral atlanto-axial and atlanto-occipital joints have not been reported.

Methods: Five volunteers without histories of upper cervical pain underwent two joint injections each. In all five subjects, the left atlanto-occipital and right lateral atlanto-axial joints were stimulated via injection of contrast medium causing distension of the joint capsule.

Results: Referred pain was produced with all ten injections. The lateral atlanto-axial injections resulted in consistent referral patterns, whereas the atlanto-occipital referral patterns varied significantly. A tentative composite diagram of the experimentally induced pain was created for each joint.

Conclusion: This study confirms the nociceptive ability of these cervical synovial joints. This study may assist the clinician in the differential diagnosis of head and neck pain.

MeSH terms

  • Adult
  • Atlanto-Axial Joint / diagnostic imaging
  • Atlanto-Axial Joint / innervation*
  • Atlanto-Occipital Joint / diagnostic imaging
  • Atlanto-Occipital Joint / innervation*
  • Extravasation of Diagnostic and Therapeutic Materials
  • Female
  • Fluoroscopy
  • Humans
  • Injections, Intra-Articular
  • Iothalamate Meglumine
  • Male
  • Nociceptors / physiology*
  • Pain / physiopathology*
  • Pain Measurement


  • Iothalamate Meglumine