Execution
- 1Position the patient sitting and support the head.
- 2Stabilize C2 by gripping the spinous process or lamina between the finger and thumb.
- 3Side flexes the head while monitoring whether C2 follows immediately.
- 4Repeat in different degrees of cervical flexion and on both sides.
- 5Also perform the rotation stress version by stabilizing C2 and rotating the head left and right.
Positive outcome
The test is positive when abnormal motion occurs compared with the other side, when C2 does not follow normally, or when more than about 20° to 30° rotation occurs without C2 moving. Excess motion to one side suggests contralateral alar ligament compromise. Pain alone is not a definitive positive finding.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Kaale et al. (2008) | clinical test compared with MRI findings | NA | NA | NA | NA |
| Osmotherly et al. (2012) | construct validity MRI study | NA | NA | NA | NA |
| Hutting et al. (2013) | systematic review | NA | NA | NA | NA |
CommentMagee describes both lateral flexion and rotational alar stress testing, but the expected motions are small and examiner dependent. Construct validity work shows the maneuvers can stress the alar ligaments, but clinical diagnostic accuracy remains limited. Treat a suspicious result as a reason for caution or referral, not as a stand-alone diagnosis.
Low Clinical Value