Execution
- 1Position the patient supine and support the head and upper neck.
- 2Gently flex the upper cervical spine to place tension through the craniovertebral region.
- 3Apply a cautious distraction or traction force through the occiput while stabilizing the upper cervical spine.
- 4Observe for symptom reproduction, excessive motion, neurological symptoms, or protective spasm.
- 5Stop the test immediately if concerning symptoms occur.
Positive outcome
Excessive motion, neurological symptoms, marked apprehension, or reproduction of instability symptoms is positive. There is no robust bedside threshold for tectorial membrane injury. A suspicious result should be treated as a safety concern requiring further medical assessment.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Kaale et al. (2008) | clinical tests compared with MRI findings | NA | NA | NA | NA |
| Hutting et al. (2013) | systematic review | NA | NA | NA | NA |
CommentTectorial membrane stress testing is far less standardized than Sharp-Purser or alar stress testing. The structure is deep, the expected movement is small, and clinical accuracy is uncertain. Use this as a cautious safety screen only in appropriately trained hands.
Low Clinical Value