Sharp Purser Test
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Original Editor - Ben Lippe, PT
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Purpose
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To detect upper cervical instability.
Technique
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The patient is seated, with the neck comfortably semi-flexed. The examiner places the palm of one hand on the patient's forehead, and the index finger of the other hand on the tip of the spinous process of the axis (C2). The examiner pushes posteriorly on the patient's forehead. A sliding motion of the head in relation to the axis indicates atlantoaxial instability.[1] A positive result may also be accompanied by a reduction in symptoms[2], a "clunk" sensation, or patient reports of a "click" or "clunk" felt in the roof of their mouth. It is thought that this technique reduces atlantoaxial subluxation caused by forward flexion of an unstable cervical spine.
Evidence[edit | edit source]
Atlantoaxial instability is the most significant complication of rheumatoid arthritis (RA) in the cervical spine[1], occuring in 29-70% of RA patients.[3]. Cervical spinal cord compromise due to atlantoaxial subluxation can have serious neurological consequences, including quadriplegia and even death. Uitvlugt and Indenbaum[1] compared the Sharp-Purser Test to a gold standard of lateral flexion/extension radiographs in 123 patients with rheumatoid arthritis. They report a sensitivity of 69%, and a specificity of 96% for laxity >3mm. This yields a positive likelihood ratio of 17.3 and negative likelihood ratio of 0.32. For laxity >4mm, sensitivity increased to 88%. All cases with neurological involvement and all laxities >5mm were detected.
Resources[edit | edit source]
add any relevant resources here
Recent Related Research (from Pubmed)[edit | edit source]
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References
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- ↑ 1.0 1.1 1.2 Uitvlugt G, Indenbaum S. Arthritis and Rheumatism. 1988; 31:918-922.
- ↑ Flynn TW, Cleland JA, Whitman JM. User's Guide to the Musculoskeletal Examination--Fundamentals for the Evidence-Based Clinician. Evidence in Motion;2008:94.
- ↑ Kauppi M, Leppanin L, Heikkila S, Lahtinen T, Kautiainen H. Active conservative treatment of atlantioaxial subluxation in rheumatoid arthritis. British J Rheum. 1998:37:417-420.
