Nuchal ligament

The nuchal ligament is a ligament at the back of the neck that is continuous with the supraspinous ligament.

Nuchal ligament
Nuchal ligament
Muscles connecting the arm to the spine seen from behind (nuchal ligament labeled in red at center)
FromExternal occipital protuberance
ToSpinous process of C7
LatinLigamentum nuchae
Anatomical terminology


The nuchal ligament extends from the external occipital protuberance on the skull and median nuchal line to the spinous process of the seventh cervical vertebra in the lower part of the neck.[1]

From the anterior border of the nuchal ligament, a fibrous lamina is given off. This is attached to the posterior tubercle of the atlas, and to the spinous processes of the cervical vertebrae, and forms a septum between the muscles on either side of the neck.

The trapezius and splenius capitis muscle attach to the nuchal ligament.

In animals

In sheep and cattle it is known as the paddywhack. It relieves the animal of the weight of its head. Dried paddywhack is commonly packaged and sold as a dog treat.

In most other mammals, including the great apes, the nuchal ligament is absent or present only as a thin fascia.[2] As it is required for running, not all animals have one.[3]

All dogs (and all living Canidae - wolves, foxes, and wild dogs) possess a similar ligament connecting the spinous process of their first thoracic (or chest) vertebrae to the back of the axis bone (second cervical or neck bone), which supports the weight of the head without active muscle exertion, thus saving energy.[4] This ligament is analogous in function (but different in exact structural detail) to the nuchal ligament found in ungulates.[4] This ligament allows dogs to carry their heads while running long distances, such as while following scent trails with their nose to the ground, without expending much energy.[4]


In humans it is a tendon-like structure that has developed independently in humans and other animals well adapted for running.[2] In some four-legged animals, particularly ungulates, the nuchal ligament serves to sustain the weight of the head.


In Chiari malformation treatment, decompression and duraplasty with a harvested ligamentum nuchae showed similar outcomes to pericranial and artificial grafts.[5]

Additional images

Anatomy of the Neck Sagittal Color MRI

I: Nuchal ligament


Occipital bone seen from outside (nuchal lines are identified at left)


This article incorporates text in the public domain from page 290 of the 20th edition of Gray's Anatomy (1918)

  1. ^ Drake, Richard L.; Vogl, Wayne; Tibbitts, Adam W.M. Mitchell; illustrations by Richard; Richardson, Paul (2005). Gray's anatomy for students (Pbk. ed.). Philadelphia: Elsevier/Churchill Livingstone. p. 45. ISBN 978-0-443-06612-2.
  2. ^ a b Swindler, D. R., and C. D. Wood. 1973 An Atlas of Primate Gross Anatomy. Seattle: University of Washington Press
  3. ^ Bramble, Dennis M.; Lieberman, Daniel E. (2004). "Endurance running and the evolution of Homo". Nature. 432 (7015): 345–52. Bibcode:2004Natur.432..345B. doi:10.1038/nature03052. PMID 15549097.
  4. ^ a b c Wang, Xiaoming and Tedford, Richard H. Dogs: Their Fossil Relatives and Evolutionary History. New York: Columbia University Press, 2008. pp.97-8
  5. ^ Cools MJ, Quinsey CS, Elton SW (April 2018). "Chiari decompression outcomes using ligamentum nuchae harvest and duraplasty in pediatric patients with Chiari malformation type I". J Neurosurg Pediatr. 22 (1): 47–51. doi:10.3171/2018.1.PEDS17670. PMID 29652242.

External links

Costotransverse ligament

A Costotransverse ligament is a short fibrous band that connects a rib with the transverse process of vertebra. They are some of the ligaments that surround the costovertebral joint.

Degenerative suspensory ligament desmitis

Degenerative suspensory ligament desmitis, commonly called DSLD, also known as equine systemic proteoglycan accumulation (ESPA), is a systemic

disease of the connective tissue of the horse and other equines. It is a disorder akin to Ehlers–Danlos syndrome being researched in multiple horse breeds. Originally thought to be a condition of overwork and old age, the disease is now recognized as hereditary and has been seen in horses of all ages, including foals. The latest research (2010) has led to the proposed renaming of the disease from DSLD to ESPA because of the systemic and hereditary components now being found.It has been found in many horse breeds, including Arabians, Thoroughbreds, American Quarter Horses, Morgans, Peruvian Pasos, Paso Finos, American Saddlebreds, several breeds of warmblood, Appaloosas, Friesians, Missouri Fox Trotters, Tennessee Walkers, American Paint Horses, National Show Horses, and Mustangs, as well as crossbreds and mules.

DSLD was once considered a condition of the legs only, as one of the most visible signs is when the fetlocks, particularly on the hind legs, collapse into a "coon-footed" position. However, microscopic examination in necropsy has shown DSLD horses can not only be affected in the tendons and ligaments of all legs and the patella, but can have affected tissues in the nuchal ligament, eyes, aorta, skin and fascia, lungs and other organs, as well as ligaments and tendons throughout the body. Because of its systemic nature, and because connective tissue is present everywhere in a biological entity, the entire body becomes affected in multiple ways as the disease progresses. Some horses have shown an iron overload in the liver as well.

Ongoing research is working on the biochemical aspects of the disease and has found a problem in the transfer growth factor and decorin. It is strongly believed to be passed genetically, and those aspects are being studied in the search for a DNA marker.

Endurance running hypothesis

The endurance running hypothesis is the hypothesis that the evolution of certain human characteristics can be explained as adaptations to long-distance running. The hypothesis suggests that endurance running played an important role for early hominins in obtaining food. Researchers have proposed that endurance running began as an adaptation for scavenging and later for persistence hunting.

External occipital crest

The external occipital crest is part of the external surface of the squamous part of the occipital bone. It is a ridge along the midline, beginning at the external occipital protuberance and descending to the foramen magnum, that gives attachment to the nuchal ligament. It is also called the median nuchal line.

External occipital protuberance

Near the middle of the squamous part of occipital bone is the external occipital protuberance, the highest point of which is referred to as the inion. The inion is the most prominent projection of the protuberance which is located at the posterioinferior (lower rear) part of the human skull. The nuchal ligament and trapezius muscle attach to it.

The inion (ἰνίον, iníon, Greek for the occipital bone) is used as a land→÷mark in the 10-20 system in electroencephalography (EEG) recording. Extending laterally from it on either side is the superior nuchal line, and above it is the faintly marked highest nuchal line.

A study of 16th-century Anatolian remains showed that the external occipital protuberance statistically tends to be less pronounced in female remains.

Forehand (horse)

The term forehand refers to the front half of a horse's body.

Interarticular sternocostal ligament

The Interarticular sternocostal ligament is a horizontal fibrocartilaginous plate in the center of the second sternocostal joint. It connects the tip of the costal cartilage to the fibrous junction between the manubrium and the body of the sternum, dividing the joint into two parts.

Interspinous ligament

The interspinous ligaments (interspinal ligaments) are thin and membranous ligaments, that connect adjoining spinous processes of the vertebra in the spine.

They extend from the root to the apex of each spinous process. They meet the ligamenta flava in front and blend with the supraspinous ligament behind.The ligaments are narrow and elongated in the thoracic region, broader, thicker, and quadrilateral in form in the lumbar region, and only slightly developed in the neck. In the neck they are often considered part of the nuchal ligament.The function of the interspinous ligaments is to limit flexion of the spine.

Lumbocostal ligament

The Lumbocostal ligament is a fibrous band that crosses from the twelfth rib to the tips of the transverse processes of the first and second lumbar vertebrae.

Nuchal fascia

The nuchal fascia is a fascia covering the autochthonous musculature of the neck as a part of the cervical fascia. It proceeds the thoracolumbar fascia to the top (cranial). The fascia itself is made of two parts: A superficial layer (lat.: Fascia nuchae superficialis) and a deeper layer that is located among the Trapezius muscle and that sheaths the deeper cervical musculature from dorsal side. Expanding laterally, the fascia also covers the dorsal musculature. In the middle of the deeper layer a bulge is resided – the nuchal ligament.

Nuchal lines

The nuchal lines are four curved lines on the external surface of the occipital bone:

The upper, often faintly marked, is named the highest nuchal line, but is sometimes referred to as the Mempin line, and it attaches to the epicranial aponeurosis.

Below the highest nuchal line is the superior nuchal line. To it is attached, the splenius capitis muscle, the trapezius muscle and the occipitalis.

From the external occipital protuberance a ridge or crest, the external occipital crest also called the median nuchal line, often faintly marked, descends to the foramen magnum, and affords attachment to the nuchal ligament.

Running from the middle of this line is the inferior nuchal line. Attached are the obliquus capitis superior muscle, rectus capitis posterior major muscle, and rectus capitis posterior minor muscle.


Paddywhack (also spelled paddywack) or nuchal ligament (Latin: ligamentum nuchae), is a strong elastic ligament in the midline of the neck of sheep or cattle which relieves the animal of the weight of its head. It is pale yellow in colour. (The yellow colour is the elastin on the ligaments.) The name is derived from the corruption of paxwax (originally faxwax Old English hair + to grow).

The nuchal ligament is unusual in being a ligament with an elastic component, allowing for stretch. Most ligaments are mostly made of highly aligned collagen fibres which do not permit stretching.

Structurally, the nuchal ligament is formed with the association of both elastin proteins as well as type III collagen (45%). The collagen fibrils share a consistent size as well as helical pattern which gives the ligament its tensile strength. The elastin on the other hand is a protein that allows for flexibility. These two elements of the nuchal ligament maintain a complex balance which allows the constant weight bearing of the head along with multidirectional movement without damaging the durability of the ligament through over-use/stretching.

Poll evil

Poll evil is a traditional term for a painful condition in a horse or other equid, that starts as an inflamed bursa at the anterior end of the neck between vertebrae and the nuchal ligament, and swells until it presents as an acute swelling at the poll, on the top of the back of the animal's head. The swelling can increase until it ruptures and drains. It can be caused by infection from Actinomyces bovis or Brucella abortus organisms, but may also occur due to parasite infestation, skin trauma, or badly fitting horse tack. Because of modern efforts to reduce the incidence of brucellosis in livestock, horses are less exposed to the Brucella abortus organism, and hence most modern cases of poll evil arise from trauma linked to a horse striking its head against poorly designed or low-clearance structures, or to improper use of equipment, particularly leaving a halter on the horse around the clock.The term has been in use since at least the 1750s. Before modern antibiotics were developed, the condition was very difficult to treat. In the 18th century, it was treated with remedies such as vinegar, wine, elder flower and even turpentine. Today, cases caught early can be cleaned with peroxide, ice packs and diluted dimethyl sulfoxide solution, with antibiotics used to prevent or slow infection. If the infection has set in and there is a discharge, antibiotic treatment along with hot packs and surgery under local anesthesia to remove infected and dead tissue is usually required.Fistulous withers is a similar condition but on the animal's withers.

Radiate sternocostal ligaments

The Radiate sternocostal ligaments are fibrous bands that cross from the sternal end of the costal cartilage to the ventral part of the sternum.


The spinalis is a portion of the erector spinae, a bundle of muscles and tendons, located nearest to the spine. It is divided into three parts: Spinalis dorsi, spinalis cervicis, and spinalis capitis.

Splenius capitis muscle

The splenius capitis () (from Greek, Modern spléníon, meaning 'bandage', and Latin caput, meaning 'head') is a broad, straplike muscle in the back of the neck. It pulls on the base of the skull from the vertebrae in the neck and upper thorax. It is involved in movements such as shaking the head.

Sternocostal joints

The sternocostal joints also known as sternochondral joints (or costosternal articulations), are synovial plane joints of the costal cartilages of the true ribs with the sternum, with the exception of the first, which is a synchondrosis since the cartilage is directly united with the sternum. The ligaments connecting them are:

Articular capsules

Interarticular sternocostal ligament

Radiate sternocostal ligaments

Costoxiphoid ligaments

Supraspinous ligament

The supraspinous ligament, also known as the supraspinal ligament, is a ligament found along the vertebral column.


The trapezius (or trapezoid) is a large paired surface muscle that extends longitudinally from the occipital bone to the lower thoracic vertebrae of the spine and laterally to the spine of the scapula. It moves the scapula and supports the arm.

The trapezius has three functional parts: an upper (descending) part which supports the weight of the arm; a middle region (transverse), which retracts the scapula; and a lower (ascending) part which medially rotates and depresses the scapula. The trapezius is used to nod your head. It is also used to hold up your head.


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