Transverse Ligament Stress Test

Purpose[edit | edit source]

Transverse Ligament Stress Test for hypermobility of the atlantoaxial articulation.

Technique[edit | edit source]

  • The patient is placed in a supine position with the therapist supporting the patient's head with the palms and 3rd-5th fingers.[1]
  • The therapist then places the index fingers between the occiput and spinous process of C2, so the index fingers are over the neural arch of the C1 vertebra.[1]
  • The therapist then lifts the patient's head and C1 vertebra anteriorly, without allowing flexion or extension.
  • The position should be held for 10-20 seconds.[1]
  • A positive test is the recurrence of symptoms[1]:
    1. Abnormal pupil response
    2. Eye twitching or nystagmus
    3. Soft end-feel
    4. Muscle spasm
    5. Dizziness
    6. Nausea
    7. Paresthesia of the lip face or limb
    8. Lump sensation in the throat



Evidence[edit | edit source]

A study by Kaale et al. (2008) shows the Transverse Ligament Stress test has a diagnostic accuracy of sensitivity 65%, the specificity of 99%, predictive values 0.97, and positive likelihood ratios of 51.44 and negative likelihood ratio of 0.35. The predictive value and positive likelihood ratios of the transverse ligament test were found to be sufficient[4][5].

According to the study by Hutting N et al., the specificity of the test is sufficient, which means the test can be used to rule in patients with upper cervical spine instability, however, it has low Sensitivity which means it is insufficient for detecting upper cervical spine instability[5]

Resources[edit | edit source]

Pettman E: Stress tests of the craniovertebral joints. In: Boyling, JD, Palastanga N, eds. Grieve's Modern Manual Therapy: The Vertebral Column, 2nd edn. Edinburgh: Churchill Lingstone, 1994:529-538.

References[edit | edit source]

  1. 1.0 1.1 1.2 1.3 ↑ Dutton, M. (2008). Orthopaedic: Examination, evaluation, and intervention (2nd ed.). New York: The McGraw-Hill Companies, Inc.
  2. ana1117Transverse ligament stress test. Available from
  3. Jason Craig Transverse Ligament Stress Test. Available from
  4. Kaale BR, Krakenes J, Albrektsen G, Wester K. Clinical assessment techniques for detecting ligament and membrane injuries in the upper cervical spine region—a comparison with MRI results. Manual therapy. 2008 Oct 1;13(5):397-403.
  5. 5.0 5.1 Hutting N, Scholten-Peeters GG, Vijverman V, Keesenberg MD, Verhagen AP. Diagnostic accuracy of upper cervical spine instability tests: a systematic review. Physical therapy. 2013 Dec 1;93(12):1686-95.