Third Occipital Nerve, Posterior View

Description

Posterior cervical dissection exposes the third occipital nerve as the medial branch of the C3 dorsal ramus, emerging just inferior to the suboccipital region and coursing superiorly toward the lower occipital scalp. Proximally it passes deep to trapezius and splenius capitis, then threads through semispinalis capitis near the midline before becoming more superficial in the nuchal fascia. Adjacent landmarks include the external occipital protuberance and superior nuchal line superiorly, with the C2 dorsal ramus (greater occipital nerve) typically lying more superior and lateral in its ascent. Small accompanying vessels track in parallel, consistent with segmental dorsal branches in the upper neck. Third occipital neuralgia and cervicogenic headache often trace to irritation of this C3 medial branch at the C2 to C3 zygapophysial joint, a common pain generator after whiplash injury. Clear posterior layering matters because diagnostic blocks, radiofrequency ablation, and surgical exposures require you to anticipate where the nerve pierces semispinalis capitis and how it relates to the overlying trapezius aponeurosis. This is the nerve clinicians forget when the pain sits low in the occiput. Pain medicine and spine teams can pair this figure with fluoroscopic or ultrasound teaching to explain target selection for C2 to C3 medial branch blocks and third occipital nerve RFA, while anatomy faculty will find it fits neatly into head and neck modules covering posterior rami, nuchal musculature, and referred pain patterns. Medical illustrators and publishers can also use it to orient readers for posterior cervical approaches that traverse the trapezius and deeper extensor layers. Anatomical accuracy verified by SciePro's Medical Advisory Board.