Alar Ligament Test: Difference between revisions
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== Purpose<br> == | == Purpose<br> == | ||
To assess the integrity of the [[ | To assess the integrity of the [[Alar ligaments|alar ligaments]] and thus upper cervical stability.<br> | ||
== Technique<br> == | == Technique<br> == | ||
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With the patient in supine, place one hand on the occiput and use the other hand to palpate the spinous process of C2. Laterally flex or rotate the head to one side. Due to the alar ligament attachments you should feel the spinous process move to the opposite side as the ligaments become taut. Repeat on the other side. Absence of the spinous process moving to the opposite side may indicate alar ligament injury. If you block the spinous process of C2 from moving, you may stress the ligament. You should encounter a firm end-feel in this case. Significant movement may indicate ligamentous injury.<br> | With the patient in supine, place one hand on the occiput and use the other hand to palpate the spinous process of C2. Laterally flex or rotate the head to one side. Due to the alar ligament attachments you should feel the spinous process move to the opposite side as the ligaments become taut. Repeat on the other side. Absence of the spinous process moving to the opposite side may indicate alar ligament injury. If you block the spinous process of C2 from moving, you may stress the ligament. You should encounter a firm end-feel in this case. Significant movement may indicate ligamentous injury.<br> | ||
The alar ligament can have 3 directions of fiber orientation: craniocaudal, horizontal, and caudocranial. It is therefore recommended the test to be performed in 3 planes of neutral, flexion, and extension<ref>Aspinall W. [http://www.ncbi.nlm.nih.gov/pubmed/18787255 Clinical Testing for the Craniovertebral Hypermobility Syndrome]. J Orthop Sports Phys Ther. 1990;12(2):47-54.</ref>.<br> | The alar ligament can have 3 directions of fiber orientation: craniocaudal, horizontal, and caudocranial. It is therefore recommended the test to be performed in 3 planes of neutral, flexion, and extension<ref>Aspinall W. [http://www.ncbi.nlm.nih.gov/pubmed/18787255 Clinical Testing for the Craniovertebral Hypermobility Syndrome]. J Orthop Sports Phys Ther. 1990;12(2):47-54.</ref>.<br> | ||
The range of craniocervical rotation during rotation stress testing of intact alar ligaments should typically be 21 degrees or less<ref>Osmotherly PG, Rivett D, Rowe LJ.. Toward understanding normal craniocervical rotation occurring during the rotation stress test for the alar ligaments. Phys Ther. 2013 Jul;93(7):986-92. doi: 10.2522/ptj.20120266.</ref>. | The range of craniocervical rotation during rotation stress testing of intact alar ligaments should typically be 21 degrees or less<ref>Osmotherly PG, Rivett D, Rowe LJ.. Toward understanding normal craniocervical rotation occurring during the rotation stress test for the alar ligaments. Phys Ther. 2013 Jul;93(7):986-92. doi: 10.2522/ptj.20120266.</ref>. | ||
{{#ev:youtube|HSVD3Q6a5Eg}} | {{#ev:youtube|HSVD3Q6a5Eg}} | ||
== Evidence == | == Evidence == | ||
Both side-bending and rotation stress testing have been validated to result in a measurable increase in length of the contralateral alar ligament<ref>Osmotherly PG, Rivett DA, Rowe LJ. Construct validity of clinical tests for alar ligament integrity: an evaluation using magnetic resonance imaging. Phys Ther. 2012 May;92(5):718-25.</ref>. | Both side-bending and rotation stress testing have been validated to result in a measurable increase in length of the contralateral alar ligament<ref>Osmotherly PG, Rivett DA, Rowe LJ. [http://www.ncbi.nlm.nih.gov/pubmed/22267548 Construct validity of clinical tests for alar ligament integrity: an evaluation using magnetic resonance imaging]. Phys Ther. 2012 May;92(5):718-25.</ref>. | ||
== Resources == | == Resources == | ||
Revision as of 18:37, 27 January 2014
Original Editor - Rachael Lowe
Top Contributors - Rachael Lowe, Admin, Tony Lowe, Evan Thomas, Kim Jackson, Scott Buxton, George Prudden, Kai A. Sigel, WikiSysop and Claire Knott
Purpose
[edit | edit source]
To assess the integrity of the alar ligaments and thus upper cervical stability.
Technique
[edit | edit source]
With the patient in supine, place one hand on the occiput and use the other hand to palpate the spinous process of C2. Laterally flex or rotate the head to one side. Due to the alar ligament attachments you should feel the spinous process move to the opposite side as the ligaments become taut. Repeat on the other side. Absence of the spinous process moving to the opposite side may indicate alar ligament injury. If you block the spinous process of C2 from moving, you may stress the ligament. You should encounter a firm end-feel in this case. Significant movement may indicate ligamentous injury.
The alar ligament can have 3 directions of fiber orientation: craniocaudal, horizontal, and caudocranial. It is therefore recommended the test to be performed in 3 planes of neutral, flexion, and extension[1].
The range of craniocervical rotation during rotation stress testing of intact alar ligaments should typically be 21 degrees or less[2].
Evidence[edit | edit source]
Both side-bending and rotation stress testing have been validated to result in a measurable increase in length of the contralateral alar ligament[3].
Resources[edit | edit source]
add any relevant resources here
Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
- ↑ Aspinall W. Clinical Testing for the Craniovertebral Hypermobility Syndrome. J Orthop Sports Phys Ther. 1990;12(2):47-54.
- ↑ Osmotherly PG, Rivett D, Rowe LJ.. Toward understanding normal craniocervical rotation occurring during the rotation stress test for the alar ligaments. Phys Ther. 2013 Jul;93(7):986-92. doi: 10.2522/ptj.20120266.
- ↑ Osmotherly PG, Rivett DA, Rowe LJ. Construct validity of clinical tests for alar ligament integrity: an evaluation using magnetic resonance imaging. Phys Ther. 2012 May;92(5):718-25.
