Greater occipital nerve
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At the time the article was created Craig Hacking had no recorded disclosures.
View Craig Hacking's current disclosuresAt the time the article was last revised Liz Silverstone had no financial relationships to ineligible companies to disclose.
View Liz Silverstone's current disclosures- Greater occipital nerve (GON)
- Nerve of Arnold (cutaneous)
The greater occipital nerve is a cutaneous nerve, the thickest in the body, that innervates the skin from the upper neck, over the occiput, up to the vertex of the scalp 1-3.
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Terminology
The greater occipital nerve has also been known in the past - confusingly - as the nerve of Arnold. But as any student of neuroanatomy knows, the auricular branch of the vagus nerve (X) is usually called Arnold's nerve.
The use of the eponym 'Arnold' for the greater occipital nerve is now felt to be erroneous, based upon a historical misattribution. Therefore, by extension, the use of the term Arnold neuralgia, for occipital neuralgia, is also suspect and should be discarded 5.
Gross anatomy
Origin
The greater occipital nerve arises from the medial branch of the dorsal ramus of C2 1-3. By contrast, the lesser occipital nerve arises from the ventral ramus of C2.
Course
The greater occipital nerve emerges between axis (C2) and the obliquus capitis inferior muscle, hooking underneath the later and piercing semispinalis capitis (3 cm inferior and 1.5-2 cm lateral to the occipital protuberance) before ascending deep to trapezius fascia and eventually piercing trapezius (2.5 cm lateral to the occipital protuberance) 3. It continues to ascend to the occiput.
Branches and supply
It may divide into several branches before piercing trapezius. It supplies the skin over the occipital bone and the upper posterior neck.
Relations
The greater occipital nerve runs with the occipital artery in the apex of the posterior triangle 1-3.
Clinical importance
greater occipital nerve block
greater occipital neurolysis or neurectomy
occipital nerve stimulation
Related pathology
Quiz questions
References
- 1. Keith L. Moore, Arthur F. Dalley. Clinically Oriented Anatomy. ISBN: 9780683061413
- 2. Mcminn. Last's Anatomy. ISBN: 9780729537520
- 3. Chhabra A, Bajaj G, Wadhwa V, Quadri RS, White J, Myers LL, Amirlak B, Zuniga JR. MR Neurographic Evaluation of Facial and Neck Pain: Normal and Abnormal Craniospinal Nerves below the Skull Base. (2018) Radiographics : a review publication of the Radiological Society of North America, Inc. 38 (5): 1498-1513. doi:10.1148/rg.2018170194 - Pubmed
- 4. Vital JM, Grenier F, Dautheribes M, Baspeyre H, Lavignolle B, Sénégas J. An anatomic and dynamic study of the greater occipital nerve (n. of Arnold). Applications to the treatment of Arnold's neuralgia. (1989) Surgical and radiologic anatomy : SRA. 11 (3): 205-10. Pubmed
- 5. Belvís R, Guerrero ÁL. Benito's neuralgia: the first description of the occipital neuralgia was made for Spanish doctors at the beginning of the nineteenth century. (2019) Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology. doi:10.1007/s10072-019-03734-5 - Pubmed
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