Assesses for craniocervical instability through the application of lateral forces at the C1–C2 level.

  • Lateral Displacement Test

  • Individuals presenting with signs and symptoms of upper cervical instability
    • Common in patients with rheumatoid arthritis (RA), down syndrome (DS), ankylosing spondylitis (AS), or recently sustained trauma

Patient Position
  • Supine
Examiner Position
  • At patient's head
Steps of Performance
  1. Examiner places right hand on the transverse process (TP) of C1, using second Metacarpophlangeal (MCP) joint
  2. The left hand is placed on the contralateral TP of C2, again using the second MCP joint
  3. Forearms should be positioned perpendicular to the spine and parallel to the direction of movement
  4. Examiner approximates hands, applying a shearing force to the ligaments of C1 and C2
  5. Repeat, by placing the right hand of the TP on C2 and the left on C1
Alternative Methods
  1. Coupled flexion of the cervical spine before applying force
  2. Patient seated

Stresses the transverse and alar ligaments which, if loose, contribute to upper cervical instability.

General

Positives

Myelopathy

  • Atlantoaxial instability
    • Common Symptoms: Muscle spasm, radiating neurological symptoms, nystagmus, nausea, dizziness

Pertinent Negatives

Localized Pain

  • Localized pain is not considered a positive—this is test can be aggravating to the local soft tissues

DATA
TAGS
References
Cattrysse E, Swinkels RA, Oostendorp RA, Duquet W. Upper cervical instability: are clinical tests reliable?. Man Ther. 1997;2(2):91-97.
Dr. Marieta Buse, Dr. Nikita A. Vizniak. Evidence-Informed Orthopedic Assessment. Professional Health Systems Inc.; 2023.
Lateral Shear Test / Lateral Displacement Test | Upper Cervical Instability. Physiotutors. Accessed June 4, 2022.

Assesses for craniocervical instability through the application of lateral forces at the C1–C2 level.

  • Individuals presenting with signs and symptoms of upper cervical instability
    • Common in patients with rheumatoid arthritis (RA), down syndrome (DS), ankylosing spondylitis (AS), or recently sustained trauma

Patient Position
  • Supine
Examiner Position
  • At patient's head
Steps of Performance
  1. Examiner places right hand on the transverse process (TP) of C1, using second Metacarpophlangeal (MCP) joint
  2. The left hand is placed on the contralateral TP of C2, again using the second MCP joint
  3. Forearms should be positioned perpendicular to the spine and parallel to the direction of movement
  4. Examiner approximates hands, applying a shearing force to the ligaments of C1 and C2
  5. Repeat, by placing the right hand of the TP on C2 and the left on C1
Alternative Methods
  1. Coupled flexion of the cervical spine before applying force
  2. Patient seated

Stresses the transverse and alar ligaments which, if loose, contribute to upper cervical instability.

General

Positives

Myelopathy

  • Atlantoaxial instability
    • Common Symptoms: Muscle spasm, radiating neurological symptoms, nystagmus, nausea, dizziness

Pertinent Negatives

Localized Pain

  • Localized pain is not considered a positive—this is test can be aggravating to the local soft tissues