Ligamentum nuchae
The nuchal ligament is not a muscle but a critical elastic structure. It consists of two parts: the funicular part (a thick elastic cord running from the external occipital protuberance at the poll to the withers) and the lamellar part (paired sheet-like portions that extend from the funicular cord down to the spinous processes of the cervical vertebrae, typically C2–C5 or C2–C6 in modern horses). The funicular part continues caudally as the supraspinous ligament. Because it is elastic, it passively supports the weight of the head (roughly 40 kg or more) without constant muscular effort. It also stores and returns energy during head and neck oscillation at the walk and trot. This is one reason a horse can stand with its head up while resting.
Origin: External occipital protuberance (poll) and dorsal spinous processes of C2-C7 (lamellar part)
Insertion: Summit of the dorsal spinous processes of T2-T7 (withers), continuing as the supraspinous ligament
Action: Passive elastic support of the head and neck; stores and returns energy during head oscillation at walk and trot; allows the horse to raise and lower the head without constant muscular effort
Innervation: Not innervated (ligamentous tissue)
Nuchal bursitis (poll evil) can occur at the poll. Degeneration or mineralization of the lamellar portion can occur, especially around C2–C3. Displacement or injury of the funicular part can contribute to neck stiffness or abnormal head carriage. The structure is not innervated itself but is closely associated with bursae and surrounding soft tissues.
## Overview Nuchal bursitis, traditionally called poll evil, is inflammation of the bursa at the poll, often involving the nuchal ligament attachments. It causes swelling, extreme pain on poll flexio
## Overview Nuchal ligament desmitis is inflammation or degeneration of the nuchal ligament, often with calcification, particularly in the lamellar portion near C2-C3. It can cause chronic poll or up
Persistent reluctance to lower or flex the neck, or a hard swelling at the poll, should be evaluated. Balanced work and correct head carriage help maintain normal function of the nuchal ligament and associated muscles.
## Overview Nuchal bursitis, traditionally called poll evil, is inflammation of the bursa at the poll, often involving the nuchal ligament attachments. It causes swelling, extreme pain on poll flexion, and reluctance to lower the head. Infection (including Brucella, Actinomyces, or Borrelia in some regions) or trauma can be responsible. Chronic cases become disfiguring with draining tracts. ## Causes Trauma or bacterial infection of the nuchal bursa. ## Diagnosis Clinical signs, ultrasound of the bursa, and culture or polymerase chain reaction of bursal fluid. ## Treatment Surgical debridement and prolonged antibiotics for infected cases. Traumatic cases may respond to anti-inflammatories and rest. Recurrence is possible. ## Recovery and Prognosis Guarded for infectious cases. Recovery is often prolonged. ## Prevention Avoidance of poll trauma and attention to regional infectious risks. Signs include: swelling at the poll; extreme pain on flexion; draining tract if infected; reluctance to lower the head
## Overview Nuchal ligament desmitis is inflammation or degeneration of the nuchal ligament, often with calcification, particularly in the lamellar portion near C2-C3. It can cause chronic poll or upper-neck pain, reluctance to flex, and sensitivity to bridling. Mineralization is frequently seen on radiographs and may be incidental. ## Causes Chronic strain, trauma, or age-related degeneration. ## Diagnosis Radiographs showing calcified foci, ultrasound, and clinical signs of neck pain. Not all radiographic changes are clinically significant. ## Treatment Rest, anti-inflammatories, and physiotherapy for symptomatic cases. Many radiographic findings require no treatment. ## Recovery and Prognosis Good for mild cases. Chronic pain may persist in some horses. ## Prevention Avoidance of repetitive neck strain. Signs include: chronic poll or upper-neck pain; reluctance to flex; sensitivity to bridling; calcified foci on radiographs (may be incidental)
Nuchal bursitis (poll evil) can occur at the poll. Degeneration or mineralization of the lamellar portion can occur, especially around C2–C3. Displacement or injury of the funicular part can contribute to neck stiffness or abnormal head carriage. The structure is not innervated itself but is closely associated with bursae and surrounding soft tissues.
Persistent reluctance to lower or flex the neck, or a hard swelling at the poll, should be evaluated. Balanced work and correct head carriage help maintain normal function of the nuchal ligament and associated muscles.
See the Nuchal Ligament on our interactive 3D horse model. Open 3D Model