Transverse Ligament Stress Test

Transverse Ligament Stress Test is used to assess the hypermobility at the atlanto-axial articulation and the integrity of transverse ligament.

How to perform the Transverse Ligament Stress Test?

The patient lies supine with the examiner supporting the occiput with the palms and the third, fourth, and fifth fingers. The examiner places the index fingers in the space between the patient’s occiput and C2 spinous process so that the fingertips are overlying the neural arch of C1. The head and C1 are then carefully lifted anteriorly together, allowing no flexion or extension. This anterior shear is normally resisted by the transverse ligament. The position is held for 10 to 20 seconds to see whether symptoms occur, indicating a positive test.

See Also: Alar Ligament Test

Kaale et al. advocated doing the Transverse Ligament Stress Test by stabilizing C2 from the front of the neck with the fingers pressed against the anterior aspect of the side of the transverse process on one side and the thumb in the same position on the opposite side of C2. Do not choke the patient! The examiner’s other hand is similarly placed on the posterior aspect of the transverse processes of C1 and against the inferior part of the occiput. C1 is pressed forward while C2 is pressed backward testing the translation of the dens of the atlas.

See Also: Hangman’s Fracture

What is the positive Transverse Ligament Stress Test?

Positive Transverse Ligament Stress Test when symptoms include soft end feel; muscle spasm; dizziness; nausea; paresthesia of the lip, face, or limb; nystagmus; or a lump sensation in the throat.

The Transverse Ligament Stress Test indicates hypermobility at the atlanto-axial articulation.

References & More

1. Pettman E. Stress tests of the craniovertebral joints. In: Boyling JD, Palastanga N, eds. Grieve’s Modern Manual Therapy: The Vertebral Column. 2nd ed. Edinburgh: Churchill Livingstone; 1994.
2. Kaale BR, Krakenes J, Albrektsen G, Wester K. Clinical assessment techniques for detecting ligament and membrane injuries in the upper cervical spine region–a comparison with MRI results. Man Ther. 2008 Oct;13(5):397-403. doi: 10.1016/j.math.2007.03.007. Epub 2007 Nov 1. PMID: 17936054. Pubmed
3. Orthopedic Physical Assessment by David J. Magee, 7th Edition.