Alar Ligament Test: Difference between revisions
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== Technique<br> == | == Technique<br> == | ||
=== Lateral Flexion === | |||
With the patient in supine, place one hand on the occiput and use the other hand to pinch the spinous process and lamina of C2. With the head in neutral laterally flex the head to one side. Due to the alar ligament attachments (side of the odontoid process to the medial aspect of the occipital condyles) you should feel the spinous process move to the contralateral side as the ligaments become taut. <span style="line-height: 1.5em;">Absence of the spinous process moving to the opposite side may indicate alar ligament injury. </span> | |||
<span style="line-height: 1.5em;">An altyernative method is to block the spinous process of C2 from moving. This will stress the intact ligament and you should encounter a firm end-feel in this case. Significant movement may indicate ligamentous injury.</span> | |||
=== <span style="line-height: 1.5em; font-size: 13px; font-weight: normal;">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</span><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><span style="line-height: 1.5em; font-size: 13px; font-weight: normal;">.</span> === | |||
== | === {{#ev:youtube|HSVD3Q6a5Eg}} === | ||
=== Rotational === | |||
With the patient in sitting grip the lamina and spinous process of C2 between finger and thumb. While stabilising C2 passively rotate the patients head left or right. If more than 20-30 degrees of rotation is possible without C2 moving it is indicative of injury to the contralateral alar ligament<ref>Magee, D. Orthopaedic Physical assessment Elsevier.</ref> especially if the lateral flexion alar ligament stress test is also positive. | |||
<span style="line-height: 1.5em;">The range of craniocervical rotation during rotation stress testing of intact alar ligaments should typically be 21 degrees or less</span><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><span style="line-height: 1.5em;">.</span><br> | |||
== | == 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. [http://ptjournal.apta.org/content/92/5/718.full Construct validity of clinical tests for alar ligament integrity: an evaluation using magnetic resonance imaging]. Phys Ther. 2012 May;92(5):718-25.[FULL TEXT]</ref>.<br> | |||
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | == Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | ||
Revision as of 19:23, 27 January 2014
Original Editor - Rachael Lowe
Top Contributors - Rachael Lowe, Admin, Kim Jackson, Tony Lowe, Evan Thomas, George Prudden, Kai A. Sigel, WikiSysop, Claire Knott and Scott Buxton
Purpose
[edit | edit source]
To assess the integrity of the alar ligaments and thus upper cervical stability.
Technique
[edit | edit source]
Lateral Flexion[edit | edit source]
With the patient in supine, place one hand on the occiput and use the other hand to pinch the spinous process and lamina of C2. With the head in neutral laterally flex the head to one side. Due to the alar ligament attachments (side of the odontoid process to the medial aspect of the occipital condyles) you should feel the spinous process move to the contralateral side as the ligaments become taut. Absence of the spinous process moving to the opposite side may indicate alar ligament injury.
An altyernative method is to block the spinous process of C2 from moving. This will stress the intact ligament and 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].[edit | edit source]
[edit | edit source]
Rotational[edit | edit source]
With the patient in sitting grip the lamina and spinous process of C2 between finger and thumb. While stabilising C2 passively rotate the patients head left or right. If more than 20-30 degrees of rotation is possible without C2 moving it is indicative of injury to the contralateral alar ligament[2] especially if the lateral flexion alar ligament stress test is also positive.
The range of craniocervical rotation during rotation stress testing of intact alar ligaments should typically be 21 degrees or less[3].
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[4].
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.
- ↑ Magee, D. Orthopaedic Physical assessment Elsevier.
- ↑ 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.[FULL TEXT]
