Indications

Alar Ligament Stress Test is used to assess the integrity of the alar ligaments and thus the upper cervical spine stability.


Procedure

  1. Patient supine, examiner stabilizes C2 (axis) with a grip over the lamina (not spinous process).
  2. 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
Alar ligament cervical spine test

Patient supine, examiner stabilizes C2 (axis) with a grip over the lamina (not spinous process).

Interpretation

Positive Alar Ligament Stress Test

  1. Positive Soft end feel, Muscle spasm, Pain = Alar ligament injury

Clinical Notes

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

References

Rivett DA, Rowe LJ. “Construct validity of clinical tests for alar ligament integrity; an evaluation using magnetic resonance imaging.” Physical Therapy 2012 May. Epub 2012 Jan 19. Web. 08/18/2012.

Aspinall W. “Clinical Testing for the Craniovertebral Hypermobility Syndrome.” Journal of Orthopedic & Sports Physical Therapy 1990. Web.