Alar Ligament Stress Test

Execution:

  1. Patient is in supine position
  2. The examiner grips and stabilizes the spinous process of C2
  3. The examiner assesses range of motion and end-feel of side-bending on both sides
  4. The examiner then assesses range of motion and end-feel on both sides for rotation

 

Positive Outcome:  Side-bending: More than minimal side-bending and/or soft end-feel.
Rotation: Excessive range of motion compared to the other side and/or a soft end-feel

Study

Reliability Sn Sp LR+

LR-

Hutting et al. (2013)

NA

69-72 96-100 16.37-94.09

0.33-0.29

Piekartz et al. (2019):
Rotation

NA

80 69.2 2.6

0.29

Piekartz et al. (2019):
Lateral Flexion

NA

80 76.9 3.46

0.26

Comment: Ipsilateral side-bending and rotation assesses the contralateral alar ligament. Due to the low sensitivity this test cannot exclude instability, but moderately decrease the post-test chance of an alar ligament insufficiency