Upper Cervical Flexion Test | Transverse Ligament Assessment
Upper cervical spine instability has a prevalence rate of 0.6% according to Beck et al. (2004) and is associated with inflammatory conditions such as rheumatoid arthritis, ankylosing spondylitis, as well as trauma and congenital deviations such as Down’s syndrome or Marfan’s disease. In order to safely apply manual therapy techniques to the cervical area, it is necessary to screen for possible upper cervical instability.
According to Cattrysse et al. in the year 1997, the upper cervical flexion test has an intra-rater reliability of -0.27 to 1, so poor to perfect, and an inter-rater reliability of Kappa 0.64 to 1, which is substantial to perfect. However, this test has not been evaluated by diagnostic studies, which is why we are giving it a questionable clinical value.
In order to perform the test, have your patient in supine position and stand at the head of the bench. Fixate vertebrae C3 with a key grip into ventrocranial direction. Place your other hand high on the occiput and fixate your patient’s forehead with your shoulder or chest. Now perform a gentle flexion movement.
This test is positive if your patient reports symptoms of dura compression, which is diffuse pain on several segments of the upper back and head, or spinal cord compression, which indicates a tear of the transverse ligament.
The fixation of C3 is different from the common literature which describes a fixation of C2. The problem with a fixation of C2 is that we are preventing the dens of C2 from tilting backward and thus from pinching the dura mater or the myelum. The Upper Cervical Flexion test, however, is a provocation test. By performing an upper cervical nod, the condyles of C0 roll forwards and slide backward taking the very mobile atlas/C1 with them in posterior direction. When the anterior arch of the atlas impacts the dens, the dens of C2 is tilted backward. This backward tilt and translation can be excessive in case of a torn transverse ligament, possibly pinching the dura mater or the myelum. As a side-note, the backward tilt of the dens of C2, in turn, causes an extension movement of C2 on C3. The exact opposite movement occurs with upper cervical extension. In this case, an intact transverse ligament will tilt the dens of C2 anteriorly, causing a flexion movement between C2 on C3.
21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE
Other orthopedic tests to assess upper cervical instability are:
What customers have to say about the Assessment E-Book
The Assessment E-Book This book helped me in my studying for my exam and in assessing my first patients. Awesome! Also for beginners!
The Assessment E-Book It’s an amazing Compilation! Congrats to all the work you have put in there. You’ll propably find all the test’s you’ve been looking for with propper explaination and source to doublecheck for you self. definetly a must have for every student, but it will also help an experienced practioner. Im looking forward to the lifelong updates on the topics.
Great work, guys
The Assessment E-Book A must-have for all physiotherapists, osteopaths and manual therapists. The authors conducted an extensive research on assessment tests in manual therapy. I find it very easy to read. The more I read the more I learn. Thank you!
The Assessment E-Book This book is great! It is very structured and detailed. It works extremely well on my Macbook and iPad.
The Assessment E-Book The best way to spend 80euros. Totally worth it. The amount of work you put behind this must have been absolutely huge. Every physical or physiotherapist should own it.
Congrats guys you’ve done an incredible job.
I’ve learnd a lot of new things and my approach to therapy in general have totally changed.
In one word: amazing. Keep going guys ! Best wishes from france.
This content is for members
Create your free account to gain access to this exclusive content and more!
The technical storage or access is strictly necessary for the legitimate purpose of enabling the use of a specific service explicitly requested by the subscriber or user, or for the sole purpose of carrying out the transmission of a communication over an electronic communications network.
The technical storage or access is necessary for the legitimate purpose of storing preferences that are not requested by the subscriber or user.
The technical storage or access that is used exclusively for statistical purposes.The technical storage or access that is used exclusively for anonymous statistical purposes. Without a subpoena, voluntary compliance on the part of your Internet Service Provider, or additional records from a third party, information stored or retrieved for this purpose alone cannot usually be used to identify you.
The technical storage or access is required to create user profiles to send advertising, or to track the user on a website or across several websites for similar marketing purposes.