Transverse Ligament Stress test is a cervical spine examination procedure that tests for hypermobility of the atlantoaxial articulation.


Patient should be awake and cooperative while the Transverse Ligament Stress test is being performed.

  1. Patient should be supine while the test is being done.
  2. The examiner supports the patient’s head using two hands. His fingertips should be along the posterior arch of C1.
  3. The examiner lifts the head of the patient anteriorly ~5 cm. The lift should be done without any flexion or extension of the neck muscles. The examiner holds this position for 15 seconds.
  4. The examiner takes note of any muscle spasm, dizziness, nystagmus, nausea or soft end feel along the head area.



Positive Transverse Ligament Stress Test

There is positive Transverse Ligament Stress test when there is a soft end feel, muscle spasm, dizziness, nausea and nystagmus. These symptoms indicate hypermobility of the atlantoaxial articulation.

Clinical Notes

The transverse ligament plays a huge role in holding the odontoid process of C2 against the anterior arch of C1. Rupture of the transverse ligament results in atlantoaxial instability which is seen in patients with previous trauma, rheumatoid arthritis and Downs Syndrome. After a positive test, diagnostic imaging, including cervical flexion and extension, should be done right away.