The atlantoaxial lateral joint capsules enclose the paired lateral atlantoaxial joints between the inferior articular facets of the atlas and the superior articular facets of the axis. They are loose and allow the 50 degrees of rotation that occurs at C1-C2. The capsules are thickened posterolaterally and are reinforced by the accessory atlantoaxial ligaments.
Contains synovial fluid in the lateral atlantoaxial joints; provides secondary rotational restraint; loose construction allows the extensive rotation required at C1-C2.
Atlantoaxial capsular tears occur in high-energy cervical rotation injuries and contribute to rotatory subluxation. In rheumatoid arthritis, capsular inflammation and erosion allow lateral mass subluxation at C1-C2, visible on open-mouth odontoid as asymmetric lateral mass displacement. Rotatory atlantoaxial subluxation in children (Grisel syndrome) develops after upper respiratory tract infections and presents with cock-robin head posture, managed by collar immobilisation and occasionally surgical reduction and fusion.
Capsular laxity and lateral atlantoaxial joint subluxation producing the cock-robin head posture (lateral tilt with contralateral rotation) in children, classified by Fielding-Hawkins system and managed by traction and collar or surgical fusion in fixed cases.
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