The Third Cervical Vertebrae, abbreviated C3, is one of seven vertebral segments to comprise the Cervical Spine . C3, C4 , C5 and C6 vertebrae are often grouped together because of their similar characteristics. While their bony structures resemble each other, their Nerve Root innervation, Pain presentation and treatment protocols are distinct. This page details the structure of this vertebral segment, its function as an extensive attachment site and the nerves it gives rise to.
The rectangular bodies of C3-6 are wider laterally than they are in an anteroposterior direction with a concavity to their inferior and superior surfaces that is generally flatter in other vertebrae (SOURCE-3). The surfaces are less comparable at their margins where on the superior surface they raise posterior-lateral hooks known asUncinate Processesand on the inferior surface the anterior and posterior margins are exacerbated (SOURCE-4). The Uncinate Processes are congruent with the superior vertebrae (C3- C7 ), forming smallUncovertebral Joints(SOURCE-4). When these joints are damaged, this can be relayed onto the intervening outer rings (annuli) of the Intervertebral Discs (SOURCE-4).
The C3- C6 Pediclesare shorter, typically curved in a posterolateral direction and extend thinLaminaeposteromedially which form the lateral walls of theVertebral Foramen(orVertebral Canal) (SOURCE-4). This triangular canal facilitates the passage of the Spinal Cord which is particualry thick in the Cervical Spine due to the addition of the Cervical Plexus and Brachial Plexus (SOURCE-4). The lateral walls of the canal meet posteriorly at theSpinous Processwhich for C-3-6 are short and bifid (SOURCE-4).
Between C3- C6 corresponding superior and inferior articular processes from adjacent vertebrae meet at Zygapophyseal Joints (orFacet Joints). Collectively the C3-C6 vertebrae and the intervening Facet Joints form theArticular Pillar, a column-like structure whose orientation and architechture provide the Cervical Spine with stability while permitting significant Range of Motion .
TheTransverse Processesin this region are short lateral extensions that give offAnterior and Posterior Tubercleswhich are unique to the Cervical Spine and serve as attachment sites (SOURCE-4).
Compared with other vertebrae of the Cervical Spine , C3-6 have (SOURCE-3+4):
Spinous Process- short and bifid, so short certain muscles such as the Trapezius and Splenius Capitis attach to Nuchal Ligament rather than vertebrae
Body- smallest in Vertebral Column . Broader side to side, than front to back
Laminae- narrow and thin. Forms a large Lamina Groove
Articular Pillars- the superior and inferior articular processes are fused to form a pillar
Transverse Processes- consist of two parts that are separated by a deep sulcus or canal which provides a passage for the corresponding spinal nerve:
Anterior part - arises from the side of the body and finishes at the Anterior Tubercle
Posterior part - the ‘true’ transverse process, ends at the Posterior Tubercle
Transverse Foramen- passage for neurovascular structures, primarily the Vertebral Artery and its accompanying veins and sympathetic nerves
With the several bony protuberances and landmarks, C3 serves as the attachment site for many soft-tissues (SOURCE-3+12):
Deep Stabilisers - short muscles associated with the Spinous Process and Transverse Process (SOURCE-12):
Multifidus - insert onto the lateral aspects and tips of Spinous Process
Semispinalis Cervicis - insert onto the Spinous Process
Rotatores - Transverse Process to Spinous Process of higher segment
Interspinalis Cervicis - course between each segments Spinous Process
Spinotransverse Group - superficial muscles
Splenius Cervicis - arises from thePosterior Tubercleof Transverse Process
Levator Scapulae - attaches toPosterior Tubercleof the Transverse Process
Prevertebral Group - deep anterior muscles
Longus Colli - the Transverse Process serves as an origin for the Superior Oblique Portion, while the anterior vertebral body recieves a portion of the Vertical Intermediate Portion (SOURCE-3)
Longus Capitis - arises from theAnterior Tubercleof the Transverse Process
Lateral Muscles
Middle Scalene - arises from thePosterior Tubercleof Transverse Process
Anterior Scalene - arises fromAnterior Tubercleof Transverse Process
Intervertebral Discs (above and below)
Ligament s
Region
Deep Back Arm Line - direct attachment through Levator Scapulae
Superficial Back Arm Line - through Trapezius
Deep Front Line - multiple direct attachments
Lateral Line - direct attachement through Sternocleidomastoid / Forward Head Posture
Spiral Line - direct attachement through Splenius Cervicis and Rhomboids
Superficial Back Line - through Erector Spinae
Unlike the rest of the Vertebral Column , Nerve Roots of the Cervical Spine exit superior of their corresponding vertebrae. The C3 Nerve Root traverses the inferior surface of C2 - Axis and superior surface of C3. There is known variation in the course and formation of these peripheral nerves.
Direct Nerve Root branches:
Longus Capitis - ( C1 - Atlas , C2 - Axis , C3 and sometimes C4 and C5 )
Levator Scapulae (C3, C4 and sometimes C5 )
Peripheral Nerve - the C3 Nerve Root lends fibres to the following nerves:
Ansa Cervicalis - ( C1 - Atlas , C2 - Axis , C3)
Greater Auricular Nerve - ( C2 - Axis and C3) (sensory)
Transverse Cervical Nerve - ( C2 - Axis and C3) (sensory)
Supraclavicular Nerve - (C3 and C4 ) (sensory)
Phrenic Nerve - (C3, C4 , C5 )
The following structures are innervated by the C3 Nerve Root :Motor:
Diaphragm - ( Phrenic Nerve )
Deep Posterior Neck Muscle s
Semispinalis Capitis - (third Occipital Nerves )
Longissimus Capitis - (dorsal rami of corresponding Spinal Nerves )
Splenius Capitis - (dorsal rami of C2 - Axis and C3)
Iliocostalis Cervicis - (dorsal rami of C3 likely highest spinal nerve root to innervate)
Infrahyoids - the majority of Infrahyoids recieve nervous innervation from the Ansa Cervicalis that arises from C1 - Atlas , C2 - Axis and C3 Nerve Roots (SOURCE-9)
Prevertebral Muscle s
Longus Capitis - ( C1 - Atlas , C2 - Axis , C3 and sometimes C4 and C5 )
Longus Colli - (ventral rami of C2 - Axis , C3, C4 , C5 and C6 )
Middle Scalene - (ventral rami of C3- C8 ) with the most superior attachment of the Scalenes , the Middle Scalene is often the only one to receive innervation this high (SOURCE-10)
Sternocleidomastoid - (ventral rami of C2 - Axis , C3 and C4 ) thought predominantly to be sensory although may have minor motor function (SOURCE-3+11)
Scapula Stabilisers
Levator Scapulae - (ventral rami of C3 and C4 ) enter the muscle from its lateral border (SOURCE-1)
Trapezius - inserts onto the Spinous Process via the Nuchal Ligament
Sensory:
Dermatomes - anteriorly, C3 provides cutaneous sensory innervation over the Upper Trapezius , while posteriorly C3 covers a small oblique band that extends from the occipital region distolaterally towards the Trapezius (SOURCE-6)
Trapezius - the sensory (proprioceptive) functions of this muscle are performed by C3 and C4 (SOURCE-7)
Sternocleidomastoid - branches of the ventral rami of C2 - Axis , C3 and C4 pierce the muscle and perform predominately sensory/ proprioceptive functions (SOURCE-3+11)
C2 - Axis -C3 Zygapophyseal Joints - particularly when compared to lower Cervical Spine nerves, the distribution of the sensory Facet branches is highly variable (SOURCE-8). Most often aMedial Branch of the Dorsal Ramus(or two) follows a course towards and innervates the deep spinal muscles and corresponding Facet joints. In this region, the C3 may also give rise to singular direct branches that course straight towards the anterior (facet) Zygapophyseal Joint Capsule (SOURCE-8). Nerve fibres in this region are also often interconnected (SOURCE-8)
While C3 is subject to many of the traumatic and degenerative pathologies that affect the Vertebral Column and their associated soft-tissues, the following discusses pathologies that are region specific. Akin to stepping on a running gardenhose, misalignment of C3 affects the exiting Nerve Root , known as a Radiculopathy , which may compromise the sensory or motor functions of the tissues it innervates. Relatively speaking, a C3 Radiculopathy is considered uncommon (SOURCE-2). Additionally, misalignment of C3 may lead to approximation of its Zygapophyseal Joints and consequent referral.
Cervicogenic Headache - the referred Pain pattern for both the C2 - Axis /C3 and C3/ C4 Zygapophyseal Joints extends into the upper cervical region, with the proximal joints referring further superior and onto the head (SOURCE-14). As Cranial Nerve V and the upper three Cervical Spine nerves converge a central processing area known as the Trigeminocervical Nucleus , information between nerves may be confused (SOURCE-15). In these instances patients often display neurological symptoms in both nerve distributions, forming another avenue for headaches (SOURCE-15). C3 also lends sensory fibres to Peripheral Nerves such as the Lesser Occipital Nerves and Greater Auricular Nerve which innervate the head.
C3 Radiculopathy has the capacity to alter sensation along any of the Dermatomes of the Peripheral Nerves it lends fibres to, including Greater Auricular Nerve , Transverse Cervical Nerve , Supraclavicular Nerve . Similarly, palsy of any of the C3 motor branches may compromise muscle function to any of the Muscles it directly or indirectly innervates.
Although rare, a Neuropathy of particular concern is Diaphragm atic paralysis that may result from palsy of the Phrenic Nerve which arises from ventral rami of C3, C4 and C5 (SOURCE-16). As C4 is the predominant contributor of nerve fibres, it is most common segement implicated in this injury, usually in the form of a Radiculopathy (SOURCE-16+17). A C2 - Axis /C3 Myelopathy , where the Spinal Cord itself is compressed, may also compromise the C4 neuromere prior to it exiting as a Nerve Root (SOURCE-16). In either instance, chronic disturbance to the Phrenic Nerve can lead to both trophic and nutritional disturbance which causes weakening and dysfunction of the Diaphragm (SOURCE-17).
The following observations may be related to C3 pathology/dysfunction:
Headaches worse with Cervical Spine movement - suggests Cervicogenic Headache (SOURCE-13). This type of headache is typically described as a dull Pain or internal pressure and may be bilateral, occipital, frontal or facial (SOURCE-13)
Weakness in neck movements, particularly Cervical - Lateral Flexion , Cervical - Extension or Cervical - Flexion
The Nerve Root may be evaluated by virtue of the perfomance of the Muscles that share its innervation, known as Myotomes . For C3, a Cervical - Lateral Flexion force is applied to the side of the patients head while they isometrically contract and attempt to prevent movement (SOURCE-13). The practitioner may stabilise the patients opposing shoulder with their free hand. As other muscles also contribute to this movement it does not isolate C3 for evaluation.
The Nerve Root may also be evaluated through its sensory distribution, known as a Dermatomes . For C3, anteriorly cutaneous sensory innervation covers the Upper Trapezius , while posteriorly C3 covers a small oblique band that extends from the occipital region distolaterally towards the Trapezius (SOURCE-6).
The following Special Tests may be relevant in evaluating C3 dysfunction:
Spurling’s Test - reproduction of patients referred Pain suggests Radiculopathy or compression of Zygapophyseal Joints
Cervical Distraction Test - alleviation of patients referred Pain suggests Radiculopathy or compression of Zygapophyseal Joints
Cervical Quadrant - approximates Zygapophyseal Joints
Mobilisations - particular Joint Play techniques may be used to evaluate the relative positon and movement available to the individual vertebral segments. In a similar fashion, the effectiveness of a Mobilisation with Movement technique applied to a particular joint/ motion may serve as a diagnostic finding
For treating symptoms of Pain or restriction in any of the soft-tissues innervated by C3, see the treatment section of their respective pages. The following techniques may be used to improve the Mobility and relative position of C3 with the hopes of reducing radicular symptoms.
Stretching techniques used to improve the relative position of C3 generally aim to restore length in the superficial Cervical - Flexion Muscles to reduce the extent of Forward Head Posture (SOURCE-5). Additionally, restoring length to related fascial continuities has the capacity to improve C3 posture and movement.
Door Frame Neck Stretch - self-guided neck stretch with several variations
Seated Thoracic Rotation with Breathing - large lateral flexion and rotation range coupled with breathing
Swimmers Oblique Extensions - exercise that may be used to lengthen entire Lateral Line through large body-wide lateral-flexion range
Bent Over Lat Stretch - accessible active stretch with large GH Joint - Flexion or Horizontal GH Joint - Adduction range
Jefferson Curl - maximal stretch for posterior chain with emphasis on intersegmental movment of the Vertebral Column and capacity to add load
The Fascia l continuities described below may influence the resting tone of soft-tissues that attach to C3 to remotely impact its resting postion and ability to articulate. In some instances the release of a single structure contained within a fascial continuity forms an effective treatment, while in others the entire Fascial Lines may require attention.
Deep Back Arm Line - direct attachment through Levator Scapulae
Deep Front Line - multiple direct attachments
Lateral Line - direct attachement through Splenius Capitis / Sternocleidomastoid
Spiral Line - direct attachement through Splenius Cervicis
Superficial Back Line - through Erector Spinae
Superficial Front Line - shortened Sternocleidomastoid perpetuates Forward Head Posture
The following Strength techniques emphasise quality movement of the Cervical segmentsInitial Phase:
Quadruped
Mid-Phase:
Late Phase:
Glute Bridge - Neck Bridge variant
The following Mobilisation techniques may be indicated to correct malalignment of the C3 vertebrae or treat C3 Nerve Root pathology:
Joint Play - passive accessory movements performed without active movement Passive Accessory Intervertebral Movements
Cervical - PAVIMs - mid-cervical techniques
Passive Physiological Intervertebral Movements - assess C3 through more global, cervical-wide movements. May provide insight into which physiological movements are most affected.
Mobilisation with Movement - mobilisations applied with active movement
The following tissues have Dry Needling procedures detailed on their respective pages:
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