Cervical Rotation Lateral Flexion Test | First Rib Hypomobility

Lindren and colleagues argue that hypomobility of the first rib within the upper aperture of the thoracic cage can cause neural irritation and lead to symptoms known as thoracic outlet syndrome and limit cervical range of motion as well.

In 1990, they came up with the cervical rotation lateral flexion test to assess hypomobility of the first rib, and in 1992 assessed the test’s inter-rater reliability and validity against cineradiography in assessing first rib elevation. In a sample of 23 patients, they found an excellent Kappa value of 1 and a positive test correlated with limited elevation of the first rib on cineradiography. The sample in the study is fairly small and it’s the only study that ever described this test so the clinical value remains questionable at least.

To conduct the test the patient is in sitting position. The patient’s head is rotated away from the affected side and then lateral flexion is added in the opposite direction than flexion so that the ear moves towards the patient’s chest.

The test is positive if there is no movement of lateral flexion along the axis of the costotransverse joint or if a bony restriction blocks the movement.

Another way to assess for hypomobility of the first rib is the direct assessment of first rib hypomobility.

If you are curious to learn more about joint play assessment &  treatment of the costotransversal joints, click here.

Lindgren, K. A., Leino, E., Hakola, M., & Hamberg, J. (1990). Cervical spine rotation and lateral flexion combined motion in the examination of the thoracic outlet. Archives of physical medicine and rehabilitation, 71(5), 343-344.

Lindgren, K. A., Leino, E., & Manninen, H. (1992). Cervical rotation lateral flexion test in brachialgia. Archives of physical medicine and rehabilitation, 73(8), 735-737.