Cervical stability testing is one of the most important aspects of a cervical screen. While it may not help our treatment directly, it may save some people's lives or prevent significant worsening of injury. There are several key components of cervical stability testing:
There is specific testing for Alar Ligament Integrity but for cervical fx screening, it is recommended to utilize the Canadian C-spine rules and Jefferson Fx test.
The Transverse Ligament is responsible for maintaining stability between C1 and the odontoid process of C2. Without the ligament functioning, spinal cord injury is possible. While it is rare for a patient with a ruptured Transverse Ligament to present to you in a clinic, with direct access, it is certainly possible. The patient may hold their head in a certain position (avoiding positions that aggravate symptoms), to keep the injury "reduced." There are two methods that we recommend for testing the ligament's integrity: Sharp-Purser Test and Supine Transverse Ligament Test.
While both tests can be effective for assessing stability, we recommend using both. First, the Sharp-Purser Test should be used as it is a REDUCING test. That means, if a symptomatic patient presents, you will reduce their symptoms if the test is positive. While most patients won't allow you to "provoke" their symptoms with the initial part of the test, it is still important to try reducing symptoms before aggravating. Next, we recommend using the supine Transverse Ligament Test to provoke symptoms. The force is minimal, so it is unlikely to be harmful if stopped when any appropriate symptoms are produced.
While the diagnostic accuracy for upper cervical stability and utilization of Canadian C-Spine rules is relatively high, it is not recommended to completely override clinical decision making. As always, we recommend a thorough evaluation and consideration of the evidence of each test's findings. For more information on these tests, be sure to check out the pages linked above.
-Dr. Chris Fox, PT, DPT, OCS
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