Execution
- 1Position the patient supine.
- 2Stabilize the occiput and atlas in flexion.
- 3Maintain the occiput and atlas position while supporting the patient's head.
- 4Apply a gentle anterior shear force to C1 relative to C2 as described in upper cervical instability screening.
- 5Stop immediately if neurological symptoms, excessive motion, apprehension, or symptom reproduction occurs.
Positive outcome
Excessive anterior translation, neurological symptoms, apprehension, or a sense of instability is positive. The test is intended to stress the transverse ligament when Sharp-Purser is negative but suspicion remains. It should not be forced through resistance or used casually.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Hutting et al. (2013) | systematic review | NA | NA | NA | NA |
| Aspinall (1990) | clinical testing description | NA | NA | NA | NA |
CommentMagee presents this as an additional transverse ligament stress test after Sharp-Purser. Evidence for diagnostic accuracy is limited and safety concerns are important. A history suggestive of instability or neurological compromise should prompt medical workup rather than repeated stress testing.
Low Clinical Value