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bibliography * The PainScience Bibliography contains plain language summaries of thousands of scientific papers and others sources, like a specialized blog. This page is about a single scientific paper in the bibliography, Swinkels 1996.

Upper cervical instability: fact or fiction?

updated
Swinkels RA, Oostendorp RA. Upper cervical instability: fact or fiction? J Manipulative Physiol Ther. 1996 Mar-Apr;19(3):185–194. PubMed #8728462.
Tags: neck, etiology, diagnosis, biomechanics, controversy, random, head/neck, spine, pro, debunkery

PainSci summary of Swinkels 1996?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focussed on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided at the bottom of the page, as often as possible. ★★★☆☆?3-star ratings are for typical studies with no more (or less) than the usual common problems. Ratings are a highly subjective opinion, and subject to revision at any time. If you think this paper has been incorrectly rated, please let me know.

This 1996 paper found that “there is no correlation between the measure of hypermobility and the presence of clinical symptoms. Also, the validity of the upper-cervical stability tests is questionable.”

original abstract

OBJECTIVES: The purpose of this review is to examine the internal validity of the standardized clinical stability tests for the upper cervical spine in relation to symptomatology. Whether radiology can confirm the clinical diagnosis is also examined. The importance of radiology in this situation, the pathogenesis and the prevalence of atlanto-axial hypermobility and the clinical symptomatology are discussed.

DATA SOURCES: A literature search from January 1984 to March 1995. We consulted the CD-ROM Medline with the keywords "atlanto-axial instability," "atlanto-axial dislocation," "hypermobility," "cervical spine" and "atlanto-axial joint." Ninety-six Dutch, French, German, and English publications were selected. The Documentation Centre of the Institute for Research and Postgraduate Education Physiotherapy (SWSF) was consulted with the keywords: atlanto-axial joint, upper cervical spine, segmental examination, interobserver-reliability, intraobserver-reliability, interobserver variation, intraobserver variation, manual therapy, examination, diagnostics. Finally, recent developments and views published during this study were added.

RESULTS: There seems to be no correlation between the amount of hypermobility or subluxation and the presence of clinical signs or neurological signs. The clinical signs can vary from relatively diffuse complaints, no symptoms and signs to serious ones. Radiology does not seem to be a reliable diagnostic mechanism in relation to upper-cervical instability. Conventional X-rays fail to give adequate information about atlanto-axial stability. CT-scan and MRI can visualize much more because of the direct sagittal projection but neither is an absolute standard. Furthermore, in relation to upper-cervical hypermobility, the validity of radiology is under debate.

CONCLUSION: There is no correlation between the measure of hypermobility and the presence of clinical symptoms. Also, the validity of the upper-cervical stability tests is questionable. In diagnostics, every radiological examination measures anatomical and morphological variables, not functional variables. Despite this, CT and MRI should be preferred in diagnostics over conventional functional radiology.

related content

These three articles on PainScience.com cite Swinkels 1996 as a source:


This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog.