Diagnostic accuracy and validity of three manual examination tests to identify alar ligament lesions: results of a blinded case-control study

J Man Manip Ther. 2019 May;27(2):83-91. doi: 10.1080/10669817.2018.1539434. Epub 2018 Nov 15.

Abstract

Introduction: Tests to evaluate the integrity of the alar ligaments are important clinical tools for manual therapists, but there is limited research regarding their validity.

Method: A single blinded examiner assessed alar ligament integrity using the lateral shear test (LST), rotation stress test (RST) and side-bending stress test (SBST) on a sample of convenience comprising 7 subjects with MRI confirmed alar ligament lesions and 11 healthy people. Alar ligament lesions were identified using both supine and high-field strength upright MRI.

Results: The RST had a sensitivity of 80% and a specificity of 69.2%. The SBST and the LST both showed a sensitivity of 80% and a specificity of 76.9%. In cases where all three tests were positive, the specificity increased to 84.6%.

Discussion: Tests of manual examination of alar ligament integrity have some diagnostic utility; however, these findings require further corroboration in a larger sample.

Keywords: Alar ligaments; clinical tests; validity – MRI.

Publication types

  • Validation Study

MeSH terms

  • Adult
  • Case-Control Studies
  • Female
  • Humans
  • Ligaments, Articular / diagnostic imaging
  • Ligaments, Articular / physiopathology*
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Musculoskeletal Manipulations
  • Neck / diagnostic imaging
  • Neck / physiopathology*
  • Neck Injuries / diagnosis*
  • Physical Examination / methods*
  • Reproducibility of Results
  • Rotation
  • Sensitivity and Specificity
  • Shear Strength
  • Single-Blind Method

Grants and funding

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.