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

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

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics Approval

The study was conducted in accordance with the Helsinki guidelines and approved by the local ethics committee of the University of Applied Sciences Osnabrück (WiSO MS-MP-WS 1617-08).

Additional information

Funding

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

Notes on contributors

Piekartz Harry Von

Piekartz Harry von is Professor for Physical Therapy, course director of the MSc in musculoskeletal Therapy on the University of Applied Science in Osnabrück(Germany), clinician and researcher in head, face and neck pain.