The paired lateral atlantoaxial joints allow the 45 degrees of rotation each side that occurs at the C1-C2 level, producing approximately 50% of total cervical rotation. Their facets are convex on convex, allowing the combination of rotation and slight lateral flexion and extension that accompanies C1-C2 motion. In rheumatoid arthritis, lateral atlantoaxial joint erosion produces C1-C2 instability requiring surgical stabilisation.
Rotatory atlantoaxial subluxation in children from infection (Grisel syndrome) or trauma produces a fixed torticollis with the head locked in rotation. MRI and CT confirm the joint asymmetry. Most cases resolve with muscle relaxants and collar; chronic cases require halo or surgical C1-C2 fusion.
C1-C2 lateral joint locking producing fixed childhood torticollis managed with muscle relaxants, collar, and surgical fusion for refractory cases.
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