Cervical Rotasjon Lateral Fleksjons Test

The Cervical Rotation Lateral Flexion Test (CRLF Test) is used to assess hypomobility of the first rib in patients with brachialgia, with or without radicular pain, and to help identify thoracic outlet syndrome¹. The purpose of the test is to evaluate whether restricted mobility of the first rib may be contributing to the patient’s symptoms. It is often used as a basis for determining the need for manipulation of the upper ribs². A positive test indicates first rib hypomobility when lateral flexion is blocked at maximal cervical rotation³.

Execution of the Test

• Patient position: The patient sits upright

• Movement sequence:

  • The cervical spine is maximally rotated away from the side being tested

  • The neck is then laterally flexed by bringing the ear toward the chest

• Positive test: Lateral flexion is blocked

• Documentation: Results are recorded in the patient’s chart⁴

Interpretation of Results

• A positive CRLF Test indicates reduced mobility of the first rib and may be associated with brachialgia or thoracic outlet syndrome⁵

• One study reported diagnostic accuracy of 84% and a kappa value of 1.0, indicating high reliability and reproducibility⁶

• Although the test is often used to decide whether rib manipulation is appropriate, it does not necessarily predict which patients will benefit from such treatment⁷

Summary

The Cervical Rotation Lateral Flexion Test is a reliable and simple clinical tool for assessing first rib hypomobility in patients with brachialgia or suspected thoracic outlet syndrome. A positive finding suggests restriction of rib mobility, but results should be interpreted in combination with other clinical findings and patient history before treatment decisions are made.

Sources:

1. Lindfren K-A, Leino E, Hakola M, Hamberg J. Cervical spine rotation and lateral flexion combined motion in the examination of the thoracic outlet. Arch Phys Med Rehabil 1990; 71: 343-344.

2. Lindgren KA, Leino E, Manninen H. Cervical rotation lateral flexion test in brachialgia. Archives of physical medicine and rehabilitation. 1992 Aug 1;73(8):735-7.

3. Flynn TW, Cleland JA, Whitman JM. Users' guide to the musculoskeletal examination: fundamentals for the evidence-based clinician. United States; Evidence in motion: 2008.

4. Koppenhaver SL, Morel T, Dredge G, Baeder M, Young BA, Petersen EJ, Fernández-de-Las-Peñas C, Gill N. The validity of the cervical rotation lateral flexion test in predicting benefit after manipulation treatment to the first and second rib. Musculoskeletal Science and Practice. 2022 Dec 1;62:102629.