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Construct Validity of Clinical Tests for Alar Ligament Integrity: An Evaluation Using Magnetic Resonance Imaging.

Background. The alar ligaments are integral to limiting occipito-atlanto-axialrotation and lateral flexion and enhancing craniocervical stability. Clinical testing of these ligaments is advocated prior to the application of some cervical spine manual therapy procedures. Given the absence of validati...

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Published in:Physical Therapy Vol. 92; no. 5; pp. 718 - 726
Main Authors: Osmotherly, Peter G., Rivett, Darren A., Rowe, Lindsay J.
Format: diagnostic images pictorial research tables/charts Journal Article
Published: Oxford University Press / USA May2012
Online Access:View this record in EBSCOhost
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      dt: May2012
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      pub: Oxford University Press / USA
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        10.2522/ptj.20110261
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        atl: Construct Validity of Clinical Tests for Alar Ligament Integrity: An Evaluation Using Magnetic Resonance Imaging.
      aug:
        au:
          Osmotherly, Peter G.
          Rivett, Darren A.
          Rowe, Lindsay J.
        affil: School of Health Sciences, University of Newcastle, University Drive, Newcastle, New South Wale, Australia
      sug:
        subj:
          Instrument Validation
          Ligaments, Articular Analysis
          Magnetic Resonance Imaging
          Clinical Assessment Tools Evaluation
          Atlanto-Occipital Joint
          Image Processing, Computer Assisted
          Body Weights and Measures
          Clinical Assessment Tools
          Manipulation, Orthopedic
          Physical Examination Methods
          Validation Studies
          Construct Validity
          Wilcoxon Signed Rank Test
          Data Analysis Software
          Intraclass Correlation Coefficient
          Adult
          Female
          Male
          Human
          Funding Source
          Adult: 19-44 years
          Female
          Male
      ab: Background. The alar ligaments are integral to limiting occipito-atlanto-axialrotation and lateral flexion and enhancing craniocervical stability. Clinical testing of these ligaments is advocated prior to the application of some cervical spine manual therapy procedures. Given the absence of validation of these tests and the potential consequences if manipulation is applied to an unstable upper cervical spine segment, exploration of these tests is necessary. Objective. The purpose of this study was to examine the direct effect of the side-bending and rotation stress tests on alar ligaments using magnetic resonance imaging (MRI). Design. This was a within-participant experimental study. Methods. Sixteen participants underwent MRI in neutral and end-range stress test positions using proton density-weighted sequences in a 3-Tesla system. Measurements followed a standardized protocol relative to the position of the axis. Distances were measured from dens tip to the inferior margin of the foramen magnum and from midsubstance of the dental attachment of the ligament to its occipital insertion. Between-side differences were calculated for each measurement to account for inherent asymmetries in morphology. Differences were compared between the test and neutral positions using a Wilcoxon signed rank test.Results. Side-bending stress tests produced a median between-side difference in ligament length of +1.15 mm. Rotation stress tests produced a median between-side difference in ligament length of +2.08 mm. Both results indicate increased measurement of the contralateral alar ligament. Limitations. Assessment could be made only in the neutral position due to imaging limitations. Clinical texts state that tests should be performed in 3 positions:neutral, flexion, and extension. Conclusions. Both side-bending and rotation stress testing result in a measurable increase in length of the contralateral alar ligament. This finding is consistent with mechanisms that have been described to support their use in clinical practice.
      pubtype: Academic Journal
      doctype:
        diagnostic images
        pictorial
        research
        tables/charts
        Journal Article
      ougenre: Article
    language: English
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