The atlanto-axial joint is a

joint A joint or articulation (or articular surface) is the connection made between bones, ossicles, or other hard structures in the body which link an animal's skeletal system into a functional whole.Saladin, Ken. Anatomy & Physiology. 7th ed. McGraw- ...

in the upper part of the

neck The neck is the part of the body in many vertebrates that connects the head to the torso. It supports the weight of the head and protects the nerves that transmit sensory and motor information between the brain and the rest of the body. Addition ...

between the

atlas bone An atlas is a collection of maps; it is typically a bundle of maps of Earth or of a continent or region of Earth. Advances in astronomy have also resulted in atlases of the celestial sphere or of other planets. Atlases have traditionally been ...

and the axis bone, which are the first and second

cervical vertebrae In tetrapods, cervical vertebrae (: vertebra) are the vertebrae of the neck, immediately below the skull. Truncal vertebrae (divided into thoracic and lumbar vertebrae in mammals) lie caudal (toward the tail) of cervical vertebrae. In saurop ...

. It is a

pivot joint In animal anatomy, a pivot joint (trochoid joint, rotary joint or lateral ginglymus) is a type of synovial joint whose movement axis is parallel to the long axis of the proximal bone, which typically has a convex articular surface. According ...

, that can start from C2 To C7.

Structure

The atlanto-axial joint is a joint between the

and the axis bone, which are the first and second

. It is a

that provides 40 to 70% of axial rotation of the head. There is a pivot articulation between the

odontoid process In anatomy, the axis (from Latin ''axis'', "axle") is the second cervical vertebra (C2) of the spine, immediately inferior to the atlas, upon which the head rests. The spinal cord passes through the axis. The defining feature of the axis is its ...

of the axis and the ring formed by the anterior arch and the transverse ligament of the atlas.

Lateral and median joints

There are three atlanto-axial joints: one median and two lateral: * The median atlanto-axial joint is sometimes considered a triple joint: ** one between the posterior surface of the anterior arch of atlas and the front of the

** one between the anterior surface of the ligament and the back of the odontoid process * The lateral atlantoaxial joint involves the

lateral mass of atlas In anatomy, the atlas (C1) is the most superior (first) cervical vertebra of the spine and is located in the neck. The bone is named for Atlas of Greek mythology, just as Atlas bore the weight of the heavens, the first cervical vertebra suppor ...

and

axis An axis (: axes) may refer to: Mathematics *A specific line (often a directed line) that plays an important role in some contexts. In particular: ** Coordinate axis of a coordinate system *** ''x''-axis, ''y''-axis, ''z''-axis, common names ...

. Between the articular processes of the two bones there is on either side an arthrodial or gliding joint.

Ligaments

The ligaments connecting these bones are: *

Articular capsules In anatomy, a joint capsule or articular capsule is an envelope surrounding a synovial joint.Anterior atlantoaxial ligament The anterior atlantoaxial ligament is a strong membrane, fixed above the lower border of the anterior arch of the atlas; below, to the front of the body of the axis. It is strengthened in the middle line by a rounded cord, which connects the tube ...

* Posterior atlantoaxial ligament * Transverse ligament of the atlas

Capsule

The atlantoaxial articular capsules are thick and loose, and connect the margins of the lateral masses of the atlas with those of the posterior articular surfaces of the axis. Each is strengthened at its posterior and medial part by an accessory ligament, which is attached below to the body of the axis near the base of the

, and above to the lateral mass of the atlas near the transverse ligament.

Clinical significance

Because of its proximity to the brain stem and importance in stabilization, fracture or injury to the atlanto-axial joint can cause serious problems. Common trauma and pathologies include (but are not limited to): The dens: significant depression on the skull can push the dens into the brainstem, causing death. The dens itself is vulnerable to fracture due to trauma or ossification. Transverse ligament: Should the transverse ligament of the atlas fail due to trauma or disease, the dens is no longer anchored and can travel up the cervical spine, causing paralysis. If it reaches the

medulla Medulla (Latin for "marrow") or medullary may refer to: Science * Medulla oblongata, a part of the brain stem * Renal medulla, a part of the kidney * Adrenal medulla, a part of the adrenal gland * Medulla of ovary, a stroma in the center of the ...

death can result.

Alar ligaments In anatomy, the alar ligaments are ligaments which connect the dens (a bony protrusion on the second cervical vertebra) to tubercles on the medial side of the occipital condyle. They are short, tough, fibrous cords that attach on the skull and ...

: stress or trauma can stretch the weaker alar ligaments, causing an increase in range of motion of approximately 30%. Posterior atlanto-occipital membrane: genetic traits can sometimes result in ossification, turning the groove into a foramen.

Arthritis

Osteoarthritis Osteoarthritis is a type of degenerative joint disease that results from breakdown of articular cartilage, joint cartilage and underlying bone. A form of arthritis, it is believed to be the fourth leading cause of disability in the world, affect ...

may occur at the atlanto-axial joint. This involves classic

pathophysiology Pathophysiology (or physiopathology) is a branch of study, at the intersection of pathology and physiology, concerning disordered physiological processes that cause, result from, or are otherwise associated with a disease or injury. Pathology is ...

, such as loss of

articular cartilage Hyaline cartilage is the glass-like (hyaline) and translucent cartilage found on many joint surfaces. It is also most commonly found in the ribs, nose, larynx, and trachea. Hyaline cartilage is pearl-gray in color, with a firm consistency and has ...

osteophytes Osteophytes are exostoses (bony projections) that form along joint margins. They are distinct from enthesophytes, which are bony projections that form at the attachment of a tendon or ligament. Osteophytes are not always distinguished from exost ...

visible with

radiography Radiography is an imaging technology, imaging technique using X-rays, gamma rays, or similar ionizing radiation and non-ionizing radiation to view the internal form of an object. Applications of radiography include medical ("diagnostic" radiog ...

, and bone thickening with a narrow joint space.

Conservative management Conservative treatment is a type of medical treatment defined by the avoidance of invasive measures such as surgery or other invasive procedures, usually with the intent to preserve function or body parts. For example, in appendicitis, conservati ...

is usually effective, involving

analgesics An analgesic drug, also called simply an analgesic, antalgic, pain reliever, or painkiller, is any member of the group of drugs used for pain management. Analgesics are conceptually distinct from anesthetics, which temporarily reduce, and in s ...

Surgery Surgery is a medical specialty that uses manual and instrumental techniques to diagnose or treat pathological conditions (e.g., trauma, disease, injury, malignancy), to alter bodily functions (e.g., malabsorption created by bariatric surgery s ...

may be used in severe cases, and may have good outcomes.

Abnormal widening

A widening of the atlanto-axial joint, as measured between the posterior surface of the anterior arch of atlas and the front of the

, indicates an injury to the transverse atlantal ligament. Normally, this atlanto-dental distance is less than 2 mm, sometimes a maximum of 3 mm is accepted in men and 2.5 mm in women.

References

Bibliography

*Dalley, Arthur F; Moore, Keith L. Clinically Oriented Anatomy Fourth Edition. Baltimore. Lippincott Williams & Wilkins, 1992. *Saladin, Kenneth S. Anatomy &Physiology: the Unity of Form and Function. New York. McGraw Hill, 2007.

External links

* {{Authority control Joints Joints of the head and neck Bones of the vertebral column