The ligamentum nuchae is the cervical equivalent of the supraspinous and interspinous ligaments, forming a fibrous septum from the inion to C7 providing the posterior cervical tension band and the attachment for cervical extensor muscles. In acute whiplash, the nuchal ligament may be disrupted producing persistent posterior cervical pain. The nuchal ligament contains the most mechanoreceptors of any cervical spinal ligament, contributing to proprioception.
| Origin | External occipital protuberance and median nuchal line |
|---|---|
| Insertion | Spinous processes of C1-C7 (supraspinous ligament equivalent in the cervical spine) |
| Actions | Resists cervical flexion; attachment for cervical extensor muscles; in quadrupeds the nuchal ligament is the primary head support structure |
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The nuchal ligament is assessed by tenderness along the spinous process tips in posterior cervical pain. Its disruption in hyperflexion injuries produces the midline posterior cervical tenderness of ligamentous sprain. MRI signal in the nuchal ligament identifies higher-grade disruptions requiring immobilisation.
Hyperflexion disruption producing midline posterior cervical pain managed with soft collar and physiotherapy.
