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Lateral Shear Test | OrthoFixar 2024

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Special Test

Lateral Shear Test

Content List

Lateral Shear Test is used to determine instability of the atlanto-axial articulation caused by odontoid dysplasia. It’s also called lateral transverse shear test.

How to perform the Lateral Shear Test?

The patient lies supine with the head supported. The examiner places the radial side of the second metacarpophalangeal (MCP) joint of one hand against the transverse process of the atlas and the MCP joint of the other hand against the opposite transverse process of the axis. The examiner’s hands are then carefully pushed together, causing a shear of one bone on the other.

See Also: Hangman’s Fracture

Because this test is normally painful because of the compression of soft tissues against the bone, the patient should be warned beforehand that pain is a normal sensation to be expected.

lateral shear test cervical spine
lateral transverse shear test
Metacarpophalangeal joints against transverse processes
See Also: Atlas Fracture | Diagnosis, Classification & Treatment

What does a positive Lateral Shear Test mean?

Normally, minimal motion and no symptoms (spinal cord or vascular) are produced. This test is positive if a lateral translation occurs between the segments.

The test can also be used to test other levels of the cervical spine (i.e., C2 to C7).

Test Accuracy

A blinded case-control study to evaluate the diagnostic accuracy and validity of three manual examination tests to identify alar ligament lesions, these tests are lateral shear test (LST), rotation stress test (RST) and side-bending stress test (SBST).

The rotation stress test had a sensitivity of 80% and a specificity of 69.2%. The side-bending stress test and the lateral shear test both showed a sensitivity of 80% and a specificity of 76.9%. In cases where all three tests were positive, the specificity increased to 84.6%.

References & More

  1. Orthopedic Physical Assessment by David J. Magee, 7th Edition.
  2. Harry Von P, Maloul R, Hoffmann M, Hall T, Ruch MM, Ballenberger N. Diagnostic accuracy and validity of three manual examination tests to identify alar ligament lesions: results of a blinded case-control study. J Man Manip Ther. 2019 May;27(2):83-91. doi: 10.1080/10669817.2018.1539434. Epub 2018 Nov 15. PMID: 30935337; PMCID: PMC6484502. Pubmed
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