This may also be an important mechanism in the tearing of the artery with manipulation of the atlanto-occipital joint. Because of false positive and negative results with current manual tests for vertebral-basilar compromise it is important to develop a more reliable test. The most important task is to minimize false negative tests. This maneuver is designed to accomplish this. Begin with the patient supine and the cervical spine in the anatomical position.
Eyes are open.
Use the first two fingers and contact the transverse process of the atlas medial to the longissimus capitis. Move the splenius and semispinalis capitis medially while penetrating just past the lateral mass of the atlas inferior to the superior oblique. Without sliding, hold tension medially and superiorly just inferior to the superior oblique and superior to the atlas while slowly rotating the patient s head ipsilaterally. Hold the rotated position for 10 seconds or until symptoms develop. Vestibular vertigo is more pronounced with head movements in more than one plane.