Alar Ligament Stress Test is used to assess the integrity of the alar ligaments and thus the upper cervical spine stability.
- Patient supine, examiner stabilizes C2 (axis) with a grip over the lamina (not spinous process).
- Examiner then proceeds to laterally flex the head and Cl (atlas) to the left and right, noting the degree of joint motion and end feel
Positive Alar Ligament Stress Test
- Positive Soft end feel, Muscle spasm, Pain = Alar ligament injury
Typically, minimal lateral flexion occurs with strong capsular end feel; follow-up for a positive test should include diagnostic imaging (radiographs) with cervical flexion & extension views
Aspinall W. “Clinical Testing for the Craniovertebral Hypermobility Syndrome.” Journal of Orthopedic & Sports Physical Therapy 1990. Web.