Suboccipital Nerve

nervus suboccipitalis

The suboccipital nerve is the posterior ramus of C1, the only spinal nerve that has no cutaneous (sensory) territory. It exits the vertebral canal between the posterior arch of the atlas and the posterior atlantooccipital membrane, enters the suboccipital triangle, and supplies the muscles of the suboccipital group: rectus capitis posterior major and minor, obliquus capitis superior and inferior. The suboccipital triangle contains the vertebral artery, the C1 posterior ramus, and the C2 posterior ramus (greater occipital nerve).

Region: Neck

Clinical Relevance

Clinical Notes

The suboccipital nerve has no cutaneous distribution, so its injury produces motor deficit in the suboccipital muscles without sensory loss. It lies within the suboccipital triangle alongside the vertebral artery, making it vulnerable during posterior atlanto-axial surgery and in suboccipital approaches to the posterior fossa. C1 nerve root block at the atlantoaxial level targets the suboccipital and C1 ventral ramus for cervicooccipital pain. Hypertonic dehydration of the suboccipital muscles from prolonged flexed neck posture compresses the greater occipital nerve in the suboccipital triangle, producing occipital neuralgia.

Pathology

Common Injuries & Conditions

Suboccipital Triangle Entrapment

Hypertension or fibrosis of the suboccipital muscles (rectus capitis posterior minor and obliquus capitis inferior) within the suboccipital triangle compresses the C1 posterior ramus and the greater occipital nerve traversing the triangle, producing cervicooccipital pain managed by suboccipital muscle dry needling and manual therapy.