What Is the Greater Occipital Nerve?

Occipital nerve: The posterior branch of the second cervical nerve is called the greater occipital nerve. This nerve penetrates the trapezius tendon to the skin, and is distributed on the skin of the occipital region, and is a mixed nerve. Such nerve damage can impair the movement and sensation of its dominated area.

Occipital nerve: The posterior branch of the second cervical nerve is called the greater occipital nerve. This nerve penetrates the trapezius tendon to the skin, and is distributed on the skin of the occipital region, and is a mixed nerve. Such nerve damage can impair the movement and sensation of its dominated area.

Chinese name

Occipital nerve

Coronal plane

60 ° angle

Sagittal plane

70 ° angle

Attributes

nerve

Overview of the occipital nerve

Posterior branch of the cervical nerve: The posterior branch of the cervical nerve is branched from the cervical nerve at the intervertebral foramen and goes backwards around the lateral side of the superior articular process, and is divided into the medial branch and lateral branch between adjacent transverse processes (except for the first cervical nerve). The lateral branches are sensory or dermal branches, and the medial branches innervate muscles and adjacent joints.

The posterior branch of the 1st cervical nerve is very small or absent. There is no cutaneous branch. The medial branch or muscle branch innervates the hemi-spinalis, the large and small rectus muscles behind the head, the superior and inferior obliques, and adjacent joints. Branch, descending and anastomosis with the 8th cervical nerve. The posterior branch of the second cervical nerve is larger than the anterior branch. The lateral branch is the greater occipital nerve, which accompanies the occipital artery. It is the main sensory branch at the back of the scalp. This branch is also related to the small occipital nerve, the great auricular nerve, and the posterior auricular nerve. And the third cervical nerve phase communication. The medial or muscular branch of the 2nd cervical nerve innervates the head, cervical semispinalis, inferior head obliques, multifidus, and adjacent joints. The posterior branch of the third cervical nerve is smaller and communicates with the second and fourth cervical nerves. The lateral branch, the third occipital nerve, is a cutaneous branch, and the medial branch innervates deep intervertebral muscles and joints. The posterior branches of the 4th to 6th cervical nerves are extremely small. The lateral innervation dominates the skin of the midline, the medial branches innervate adjacent muscles and joints, and the posterior branches of the 7th and 8th cervical nerves have no skin branches, and finally deep muscles of the upper back.

The greater occipital nerve is a branch of the posterior branch of the second cervical nerve, which is shallow below the starting line of the trapezius muscle, and branches with the occipital artery go up to the occipital skin. The third occipital nerve is a branch of the posterior branch of the third cervical nerve, which penetrates the trapezius muscle and is distributed to the upper part of the neck area. The greater occipital nerve penetrates through the fissures of the ligamentum flavum of the cervical intervertebral body. The occipital nerve is compressed, which produces radiation pain and tenderness from the occipital to the cranial-temporal.

Occipital nerve and diseases related to occipital nerve

1. Cervical occipital neuralgia syndrome: Cervical occipital neuralgia syndrome, also known as occipital neuralgia, is one of the common causes of suboccipital and posterior head pain. It is within the distribution of the major occipital nerve, small occipital nerve, and large auricular nerve. A general term for neuralgia.

Occipital great occipital neuralgia is more common clinically. Examination can find nerve tenderness at the midpoint of the line connecting Fengchi or mastoid and occipital tuberosity. At the same time, there is hypoalgesia or allergy at the top of the affected occipital.

The above occipital nerves originate from the posterior branches of the second and third cervical nerves, respectively. Occipital neuralgia is often secondary to infection or lesions of the cervical spine and adjacent tissues that spread to the upper cervical nerve roots. Care should be taken to distinguish it from non-neuronic occipital pain, such as myofiberitis, myotonic headache, hypertension, and other vascular sources Sexual headaches, etc. [1] Cervical occipital neuralgia syndrome is mainly great occipital neuralgia in the posterior branch of the second cervical nerve.

[Clinical manifestations]

(1) The pain is mainly located in the upper occipital nerve distribution area on one side of the neck and behind the occipital, and can be radiated to the top of the head. The pain is often persistent and can be aggravated by turning the head, coughing, sneezing, etc.

(2) The skin of the occipital nerve distribution area is often hypersensitive or diminished, and baldness can occur in a small number of patients.

(3) There is a tender point at the exit of the occipital nerve: the tender point of the greater occipital nerve is located at the midpoint of the line connecting the mastoid and the first cervical spine, and the tender point of the small occipital nerve is located at the posterior upper edge of the sternocleidomastoid muscle.

[Cause] Most of the symptoms are secondary to infection, cervical spine and adjacent tissue lesions spread to cervical nerves 1-4.

[Diagnosis] Diagnosis can be made based on clinical manifestations and clear tenderness points.

Occipital neuralgia usually starts on one side of the occipital region and is intermittent or exacerbated on the background of persistent dull pain. Pain can be spontaneous or induced by head movements, coughing or sneezing. During the onset, they can be radiated to the top of the head, mastoid process, or outer ear according to the distribution of the occipital nerve, occipital nerve, and auricular nerve.

2. Occipital nerve entrapment syndrome:

[Overview]

Occipital nerve entrapment syndrome is caused by trauma, strain, or inflammatory stimulus, resulting in local soft tissue exudation, adhesions, and spasms. Stimulation, compression, or pulling of the large occipital nerve, which causes radiation pain at the top of the headrest, are the main manifestations A common clinical disease.

[Needle Knife Applied Anatomy]

Anatomy of the posterior occipital surface:

Bone marks are occipital prominence, mastoid, and upper line.

Rear bow static bowstring mechanics unit:

(1) Bow

occipital bone

Same as above

cervical spine

(2) String

Cervical ligament, ligament, ligamentum flavum, interspinous ligament, intertransverse ligament, joint capsule ligament, etc. The ligament is a triangular elastic fibrous membrane. Its upper end is attached to the spinous processes of the 2nd to 7th cervical vertebrae. It is the attachment point of some muscles in the back of the neck. It stops at the outer bulge and the upper line.

Rear arch dynamic string mechanics unit:

(1) Bow

(2) String

Trapezoid muscle: It starts from the occipital protuberance, cervical spinous process, and thoracic spinous process. The muscle bundles are concentrated outward and stop at the outer 1/3 of the clavicle, the acromion and the scapula. Role: The upper muscle bundle can contract the scapula, the lower muscle bundle can lower the scapula, and the middle muscle bundle or whole muscle can pull the scapula closer to the spine.

Head semispinalis muscle: It starts from the upper 6-7 thoracic spine and the 7th cervical spine, and converges into a broad muscle and stops between the upper and lower occipital cords. Role: When both sides are contracted, the head is tilted back; when the unilateral contraction is made, the face is turned to the opposite side.

Occipitofrontalis muscle frontal abdomen: rectangular, located under the frontal skin, innervated by the temporal branches of the facial nerve. Function: Raises eyebrows and produces forehead lines.

[Etiology and Pathology]

Head work for a long time, cervical muscle spasm, deep fascial hypertrophy, inflammation exudation, adhesion, can compress the occipital nerve. Because the occipital nerve surrounds the atlantoaxial joint, it can also be stretched or injured when the atlantoaxial joint is dislocated or dislocated. Furthermore, myofasciitis of the neck muscles, especially the trapezius, can also cause this nerve to be affected. Pressure, pain in the innervated area, and local lymphadenopathy may also be the cause of pain.

[Clinical manifestations]

Symptoms: Symptoms of the occipital nerve are prominent, and they are mostly spontaneous. They are usually induced by head movements. The pain is acupuncture or knife-like. Head pain or coughing force can induce pain. The onset of pain is often accompanied by local muscle spasms, and occasionally there are sensory disturbances in the innervation area of the greater occipital nerve.

Signs: Examine the head and neck in a forced posture, with the head slightly tilted to the back, at the inner third of the line where the occipital tuberosity and the mastoid line connect (that is, where the greater occipital nerve exits the skin) and the second cervical spine and breast Deep tenderness at the midpoint of the line. There is shallow tenderness at the upper line. Each tender point can be radiated to the occipital neck, and sometimes there is still hypersensitivity or decreased sensation in the occipital nerve distribution area.

[Diagnosis points]

Occipital nerve entrapment syndrome is mainly diagnosed based on the above clinical manifestations.

[Differential diagnosis]

Clinically, it must be distinguished from falling pillow. Patients with a pillow have no history of neck trauma. When they wake up in the morning, they feel pain in one or both sides of the neck, difficulty in movement, local stiffness, head tilted to the affected side, and pain in the neck may increase, sometimes involving the shoulder and back. The sternocleidomastoid muscle is spasmodic. In severe cases, it can involve the trapezius and scapular levator muscles. It can touch the strand-like muscle bundles and local tenderness is obvious.

treatment

According to the theory of needle and knife medicine on chronic soft tissue injury and mesh theory, one side of the nerve is compressed, and the other side of the soft tissue will contract and adhere, and the occipital nerve compression will be loosened as a whole, which can completely replace open surgical loosening. Solution, cure the disease.

Manipulative treatment: Manipulative treatment is performed after the needle-knife release operation. The patient is in the prone position, and an assistant pulls both shoulders. The operator is facing the patient's head, the right elbow is flexed and the patient's jaw is supported, and the left hand's forearm is pressed against the patient For the occipital bone, press the kneading method with the movement of the neck. Do not apply excessive force to avoid new injuries. Finally, lift the shoulders on both sides and rub several times from the patient's shoulder to the forearm.