Alar Ligament Test

Conduct the Alar Ligament Test to gauge the integrity of your patient’s alar ligaments. Learn more about this test through this nifty guide!

By Matt Olivares on May 15, 2024.

Fact Checked by Ericka Pingol.

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What is the Alar Ligament Test?

Before we discuss the  let’s briefly talk about what the Alar Ligaments are.

Each person has two alar ligaments. These ligaments are small but strong. These fibrous cords connect the lateral aspect of the dens (the second cervical vertebra) to the occipital condyle, the bone in the base of the skull. What these ligaments do is that they help limit excessive rotations and lateral flexions of the head and neck of a person. If these ligaments were to get damaged or injured, the person would be at risk of developing cervical spine instability (also known as Craniocervical Instability). This instability results in excessive movement in the head and neck junction.

The Alar Ligament Test was developed to assess if a patient has potentially damaged or injured alar ligaments. Through this test, the healthcare professional examines the ligaments by having the patient sit or lie on an examination bed. The professional then uses their hands on the back of the patient’s head, and they will rotate the head gently to one side and then to the other. The professional will try to feel a clunk or a shift while moving the head.

Have a look at this video to see how the Alar Ligament Test is performed:

Printable Alar Ligament Test

Download this Alar Ligament Test to gauge the integrity of your patient’s alar ligaments.

How to perform the Alar Ligament Test

Before you start performing this on your patient, ensure you have a comfortable examination bed for them. Once the bed has been prepared, have your patient lie down on it in a supine position (they must be lying down while facing up), or you can have them sit up straight and conduct this while seated. It’s up to you how you want to go about it. Just make sure that your patient is comfortable.

Once they’re lying down in a supine position or they are sitting straight, do the following:

  • Place one of your hands on the patient’s occiput (the back of their head) and use your other hand to palpate the C2 spinous process using your index finger.
  • Once your hands are in place, you do the Lateral Flexion. You will apply slight compression on the crown of the head. You will bend the patient’s head to the right and the left. Ensure you are directing their ears toward the shoulders on their respective sides.
  • The next thing you will do is Rotation, which is the most common way to perform the Alar Ligament Test. You will perform this in flexion, extension, and neutral. For all three of these, you will stabilize the C2 with one of your hands while you grip the top of the head with the other. You will rotate the head to the right and the left.
  • The last thing that you need to do is the Lateral Shear. This one requires the patient to be seated. You will apply pressure to the C1, specifically the boney part. You will apply force to one side of the C1 to cause a shearing force between the C1 and C2.

The most common way to do this test is to do Rotation, but we suggest you do all three to get the best results possible.

How to interpret the findings of the Alar Ligament Test

While conducting the test, there are certain things you need to feel for. Here’s what you should be looking out for:

  • Clunking
  • Shifting
  • If there is a lag in the movement or side-to-side difference while performing the Lateral Flexion
  • If there is excessive movement while performing the Rotation
  • If there is movement while applying pressure during the Lateral Shear

If you notice these while performing the Alar Ligament Test, you may designate them as positive for possible alar ligament damage or injury. While you are designating them, you are not diagnosing them because there might be a chance that the suspicions that arise after performing this test may not be true. So, it’s best to include this as part of a comprehensive patient examination to confirm or refute the results of the Alar Ligament Test.

Alar Ligament Test Example

Now that you know what the Alar Ligament Test is, how to conduct it in three different ways, and how to interpret the test results, it’s time to get acquainted with our Alar Ligament Test template! The test usually doesn’t come with a sheet to record your findings, but with this template, you will see the instructions and two checkboxes to designate if they are positive or negative! It also comes with an additional comments box to indicate your comments based on your findings and observations. Here’s what it looks like.

Download this Alar Ligament Test Example (Sample) here:

Alar Ligament Test Example

If you like what you see and think this sheet will benefit your work, primarily if you practice the Alar Ligament Test, feel free to download the template for free! You can choose to print it if you like filling things out physically, or go paperless and engage with the checkboxes and additional comments box on the PDF!

When is it best to conduct the Alar Ligament Test?

If a patient sets up an appointment with you to consult about aches in their upper extremities, and when you meet, they mention that they feel pain and discomfort in their necks, then that’s one of the best times to decide to conduct the test. If they have symptoms like neck pain, stiffness, and/or even decreased range of motion, there is a chance of instability or dysfunction in the area between the neck and the head. The Alar Ligament Test can help you determine if those possibilities are likely.

Do note one of our previous statements, which is to include the Alar Ligament Test as part of a more comprehensive examination. The reason is that it should never be used as the sole reason to make decisions for your patient. It’s a physical examination technique, not a diagnostic tool; the results are gained by what you feel as you conduct it. If they test positive, the best course of action to take next is to conduct other tests, both physical examination techniques and imaging tests, to get consistent results and to confirm or refute any suspicions that arise from tests that are physical examination techniques.

What are the benefits of the Alar Ligament Test?

It is an inexpensive test to perform.

The Alar Ligament Test is a non-invasive physical examination technique. It doesn’t require anything from the conductor except to be in a clinical setting with a comfortable examination bed and/or chair for the patient. The rest of the test will rely on their expertise and their hands.

Given that it doesn’t require much from the conductor, it can be accomplished easily. If the professional conducting it is already quite experienced with this test, it should take anywhere between 3 - 10 minutes to finish.

It can help with detecting cervical spine problems early.

If a patient sets up an appointment with you and they talk about pain in their neck, then the Alar Ligament Test might be something you’d like to conduct to check them quickly and early. Conducting this test as early as the initial appointment might help detect and identify potential symptoms and problems related to the cervical spine immediately, especially if other tests are conducted. This allows healthcare professionals to provide care as soon as possible to help curb the development of whatever symptoms and problems were found.

It can help guide professionals when making care plans.

Speaking of providing care as soon as possible, the Alar Ligament Test can help professionals determine what should go into a patient’s treatment or care plan, especially when other assessments confirm the test results. The results should help tailor the plan to the patient’s needs.

It can be used to monitor patients during routine check-ups.

Let’s say that the patient tested positive for potential cervical spine-related problems when you conducted the Alar Ligament Test. Then, the symptoms/issues were confirmed by other assessments, including an MRI. After that, you and your team made a care plan for the patient, and you’ve implemented it.

If you want to check on how your patient’s been doing and if they’re getting better, you can conduct this test (gently) to check if the signs of damage or injury are still there. If they don’t show any signs of pain or discomfort as you conduct the test, then they’ve likely recovered, and the treatment plan was a success! If not, then your treatment plan might need a few adjustments or you might have to overhaul it.

Why use Carepatron for physical therapy-related work?

If you are a physical therapist, an occupation therapist, or an adjacent healthcare professional, then please take the time to browse around the Carepatron platform. You will eventually find our treasure trove of resources filled to the brim with worksheets, assessments, surveys, general treatment plans, progress note templates, and much more. It also covers numerous healthcare fields, including physical therapy!

One of the points we mentioned in this guide is that the Alar Ligament Test should not be the sole assessment you should use when assessing a patient’s upper extremities, especially their neck/spinal area. Take the time to browse around our resource library. You will eventually come across other assessments and physical examination techniques that you can use as part of a comprehensive examination of your patient, so make sure to use those alongside the Alar Ligament Test to have a better picture of your patient.

Another feature of our platform that you will surely enjoy is our storage system, allowing you to store your clinical documents with us in a HIPAA-compliant manner. If you downloaded our Alar Ligament Test template and filled out a bunch of them, you can store them with us! Doing so essentially makes backups of your files, so if you lose your physical copies, you can redownload them from the storage system and reprint them! You can even set up who gets to access these documents besides you!

We at Carepatron are all about helping healthcare professionals with their work, so take advantage of our platform so we can help streamline your workflows and help you preserve your work!

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What do the results of an Alar Ligament Test mean?
What do the results of an Alar Ligament Test mean?

Commonly asked questions

What do the results of an Alar Ligament Test mean?

If an Alar Ligament Test result is negative, that means there are no problems with the Alar Ligaments. If the test result is positive, then there is a possibility that the alar ligaments are damaged or injured, or the patient potentially has some other problem related to their cervical spine. Whatever the results are, it’s best to conduct other tests just to be sure.

How long does it usually take to accomplish the Alar Ligament Test?

Given that all you need are your hands to perform this particular test, it can take anywhere between 3 to 10 minutes, depending on how experienced you are and if you do all three methods in one sitting.

Are there any risks to conducting the Alar Ligament Test, considering you will be holding the neck?

Yes, there are risks. That’s why it’s best for a highly-trained professional to conduct it. If there is already a pre-existing condition but it’s unconfirmed that there is one, patients will likely feel a bit of pain and discomfort while the professional is conducting the technique. If the professional doesn’t know what they’re doing, they might exacerbate the pre-existing condition. Again, it’s best to leave this to those qualified to perform it.

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