Transverse Ligament Stress Test: Checking C1-C2 Stability

The Transverse Ligament Stress Test (also known as the Anterior Shear Test) is a vital safety test used to assess the stability of the upper cervical spine, specifically the integrity of the transverse ligament.

[Image of Transverse Ligament Stress Test procedure]

1. Purpose

The primary purpose of this test is to **assess the integrity** of the Transverse Ligament of the Atlas (C1). This ligament is crucial for preventing the Dens (Odontoid process) of C2 from moving backward and compressing the spinal cord. It is often tested after whiplash injuries or in patients with Rheumatoid Arthritis or Down Syndrome.

2. How to Perform

Caution: This test must be performed gently. If symptoms appear, stop immediately.

1. The patient is positioned in supine (lying on their back) with the head supported by the examiner.
2. The examiner places their index fingers on the neural arch of C1 (the atlas), between the mastoid process and the occiput.
3. The examiner supports the occiput with the palms and the other fingers.
4. The examiner lifts the head and C1 anteriorly (straight up towards the ceiling), keeping the head horizontal to the table. (This shears C1 forward on C2).
5. This position is held for 10-20 seconds to check for symptoms.

3. Positive & Negative Sign

Positive Sign (Test is POSITIVE):
A positive test (indicating ligament laxity or rupture) is the presence of a "soft" end-feel or the reproduction of symptoms such as:

• A sensation of a "lump" in the throat.
• Lip or facial paresthesia (numbness/tingling).
• Severe muscle spasm.
• Dizziness or nausea.

Negative Sign (Test is NEGATIVE):
A negative test is a firm end-feel with no reproduction of neurological symptoms.