Cervical rotation lateral flexion test

Original Editor - Sarah McBride

Top Contributors - Sarah McBride, Kim Jackson, Evan Thomas, Laura Ritchie and Rachael Lowe  


The purpose is to test for the presence of 1st rib hypomobility in patient's with brachialgia[1].


The test is performed with the patient in sitting.  The cervical spine is passively and maximally rotated away from the side being tested.  While maintaining this position, the spine is gently flexed as far as possible moving the ear toward the chest.

A test is considered positive when the lateral flexion movement is blocked

The reference standard is presence of rib hypomobility on cineradiography in subjects with brachialgia



Diagnostic Accuracy

Kappa = 0.84


Kappa = 1.0


  1. Lindfren K-A, Leino E, Hakola M, Hamberg J. Cervical spine rotation and lateral flexion combined motion in the examination of the thoracic outlet. Arch Phys Med Rehabil 1990; 71: 343-344.
  2. Flynn TW, Cleland JA, Whitman JM. Users' guide to the musculoskeletal examination: fundamentals for the evidence-based clinician. United States; Evidence in motion: 2008.