This article for continuing education describes ligamentous injuries of the upper cervical spine. Functional radiological imaging studies are particularly important in the diagnostic workup. Computed tomography can serve to visualize additional osseous traumas and magnetic resonance imaging can demonstrate discoligamentous, neuronal, and vascular structures. Traumatic ligamentous instabilities of the upper cervical spine can be categorized into four main groups: occipitocervical dislocation and translational, axial, and rotational atlantoaxial instabilities. The incidence, classification, diagnostic workup, standard treatment, and characteristics of the individual ligamentous injuries are presented. In addition, the topic of combined injuries of the upper cervical spine is addressed.