Spine
Cervical Spine
Evidence: confirmed
Alar Ligament Test Special Test
Orthopedic Physical Examination & Clinical Assessment Guide
What is it used for?
- Assessing Upper Cervical Instability (specifically the Alar Ligament which stabilizes C2).
How to Perform
- Position: Patient supine.
- Action: Grip the C2 spinous process (back of the upper neck) with a pincer grip.
- Movement: Side-bend or rotate the patient's head slightly.
Interpretation of Results
- Normal: The C2 spinous process should move immediately in the opposite direction of the side-bend.
- Positive (Instability): A lag or delay in C2 movement suggests ligament laxity.
Clinical Context & Limitations
The Alar Ligament Test should be considered as one component of a comprehensive musculoskeletal assessment. No single special test has perfect diagnostic accuracy; thus, clinical decision-making should integrate test results with patient-reported symptoms, mechanism of injury, functional impairment, and relevant imaging.
Clinicians should be aware of potential false-positive results in patients with pain sensitisation, muscle guarding, or poor relaxation. For the Spine region, combining the Alar Ligament Test with complementary examination tests significantly improves overall diagnostic confidence.
References
- Orthofixar | Alar Ligament Test
- Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.
