Execution
- 1Position the patient supine with the upper cervical spine supported.
- 2Stabilize the axis or lower cervical spine with one hand.
- 3Contact the atlas or upper cervical region with the other hand.
- 4Apply a gentle lateral shear force at the atlantoaxial region.
- 5Compare motion and symptom response side to side and stop if neurological symptoms occur.
Positive outcome
Excessive side-to-side translation, marked asymmetry, apprehension, pain, or neurological symptoms is positive. The test is intended to screen atlantoaxial lateral stability, but no single bedside response proves ligament injury. Concerning findings require cautious management and possible referral.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| von Piekartz et al. (2018) | manual upper cervical instability test validity study | NA | NA | NA | NA |
| Hutting et al. (2013) | systematic review | NA | NA | NA | NA |
CommentMagee includes atlantoaxial lateral shear among upper cervical instability screens, but the diagnostic evidence is weak. Because false negatives are possible, do not use a normal test to clear high-risk patients for end-range manual therapy. History and neurological screening carry substantial weight.
Low Clinical Value