Neck Orthopaedic Test: Transverse Ligament Stress Test

The Transverse Ligament Stress Test is a medical examination used to assess hypermobility of the atlantoaxial articulation, which is the joint between the first two vertebrae of the neck. It is often used in patients with conditions that may affect the stability of the atlantoaxial joint, such as rheumatoid arthritis, Down syndrome, or other connective tissue disorders. 

Procedure:

1. Have the patient lie on their back on an examination table with their head at the edge of the table and their shoulders supported.
2. Instruct the patient to relax their neck muscles and keep their mouth closed.
3. Stand at the head of the table and gently flex the patient's head forward, while keeping the patient's chin in a neutral position.
4. Place one hand on the patient's forehead to maintain the flexion of the head.
5. With your other hand, place your fingers on the posterior aspect of the patient's neck at the level of the C2 spinous process.
6. Apply a gentle upward pressure on the neck while maintaining the flexion of the head.
7. Observe the patient for any excessive movement or instability of the atlantoaxial joint. This may include anterior translation or subluxation of the joint, or the patient may complain of pain or discomfort.
8. Repeat the test on the opposite side.
9. If hypermobility or instability is detected, further diagnostic testing, such as imaging studies or referral to a specialist, may be necessary.

References:

1. Smoker, W. R., Khanna, G., & Kulkarni, V. (2008). Safety and efficacy of the transverse ligament axis view in pediatric atlantoaxial instability. Pediatric Radiology, 38(5), 517-525.
2. Pizones, J., Izquierdo, E., García-Granero, M., & Pérez-San-Pedro, R. (2013). Transverse ligament stress test to evaluate instability of the atlantoaxial joint: comparison of two techniques. European Spine Journal, 22(2), 389-394.
3. Haneline, M. T., & Young, M. (2012). Clinical reasoning in chiropractic practice: a key to diagnostic and therapeutic efficiency. Elsevier Health Sciences.
4. Gatterman, M. I. (2003). Foundations of chiropractic: subluxation. Elsevier Health Sciences.