Assesses for atlantoaxial instability via evaluation of the transverse ligament.

  • Sharp-Purser Test

  • atlantoaxial instability
  • subluxation of the atlas (C1) on the axis (C2)

Patient Position
  • Seated
Examiner Position
  • Standing beside the patient
Steps of Performance
  1. have the patient perform slight cervical retraction, achieving approximately 20-30 degrees of cervical flexion
    • Note: before continuing, assess for any symptoms of numbness and/or tingling of the upper extremities
  2. place the palm of one hand on the patient’s forehead, while the other hand stabilizes the spinous process of the C2 vertebrae (axis) with a pincer grip
    • Ensure both of the patient’s arms are left hanging parallel to the ground
  3. The hand located on the patient’s forehead applies an anterior to posterior force
Alternative Methods

Laxity, damage, or dysfunction of the transverse ligament (which maintains the position of the odontoid process relative to C1) can cause subluxation of C1 onto C2 during cervical flexion. The dens of C2 may compress the tracts of the spinal cord during subluxation (anterior shear) producing myelopathic symptoms such as numbness, weakness, paresthesia, and/or pain in the extremities.

General

Positives

Anterior to posterior sliding movement

  • Antlantoaxial instability
    • Note: A to P sliding movement is often accompanied by an audible “clunk” indicating reduced subluxation of the atlas

Reduced myelopathic symptoms

  • brain stem/spinal cord pressure has been reduced

Pertinent Negatives

DATA
TAGS
References
Mansfield CJ, Domnisch C, Iglar L, Boucher L, Onate J, Briggs M. Systematic review of the diagnostic accuracy, reliability, and safety of the sharp-purser test. J Man Manip Ther. 2020;28(2):72-81. doi:10.1080/10669817.2019.1667045
2. Magee DJ, Manske RC. Orthopedic Physical Assessment. St. Louis, MO: Elsevier; 2014.
Reiman MP. Orthopedic clinical examination. Champaign (IL): Human kinetics; 2015.
Mansfield CJ. Cervical myelopathy causing numbness and paresthesias in lower extremities: A case report identifying the cause of a false positive Sharp-Purser test. Physiother Theory Pract. 2019;35(4):401-408. doi:10.1080/09593985.2018.1443361
Stevens JC, Cartlidge NE, Saunders M, Appleby A, Hall M, Shaw DA. Atlanto-axial subluxation and cervical myelopathy in rheumatoid arthritis. Q J Med. 1971;40(159):391-408.
Uitvlugt G, Indenbaum S. Clinical assessment of atlantoaxial instability using the Sharp-Purser test. Arthritis Rheum. 1988;31(7):918-922. doi:10.1002/art.1780310715
Mathews JA. Atlanto-axial subluxation in rheumatoid arthritis. Ann Rheum Dis. 1969;28(3):260-266. doi:10.1136/ard.28.3.260
Forrester G, Barlas P. Reliability, and validity of the Sharp-Purser test in the assessment of atlanto-axial instability in patients with rheumatoid arthritis. Physiotherapy. 1999;85(7):376
Katayama M. Clinical and radiological evaluation of the spine due to rheumatoid arthritis. Bull Yamaguchi Med Sch. 1990;37(1–2PG–31–43):31–43.

Assesses for atlantoaxial instability via evaluation of the transverse ligament.

  • atlantoaxial instability
  • subluxation of the atlas (C1) on the axis (C2)

Patient Position
  • Seated
Examiner Position
  • Standing beside the patient
Steps of Performance
  1. have the patient perform slight cervical retraction, achieving approximately 20-30 degrees of cervical flexion
    • Note: before continuing, assess for any symptoms of numbness and/or tingling of the upper extremities
  2. place the palm of one hand on the patient’s forehead, while the other hand stabilizes the spinous process of the C2 vertebrae (axis) with a pincer grip
    • Ensure both of the patient’s arms are left hanging parallel to the ground
  3. The hand located on the patient’s forehead applies an anterior to posterior force
Alternative Methods

Laxity, damage, or dysfunction of the transverse ligament (which maintains the position of the odontoid process relative to C1) can cause subluxation of C1 onto C2 during cervical flexion. The dens of C2 may compress the tracts of the spinal cord during subluxation (anterior shear) producing myelopathic symptoms such as numbness, weakness, paresthesia, and/or pain in the extremities.

General

Positives

Anterior to posterior sliding movement

  • Antlantoaxial instability
    • Note: A to P sliding movement is often accompanied by an audible “clunk” indicating reduced subluxation of the atlas

Reduced myelopathic symptoms

  • brain stem/spinal cord pressure has been reduced

Pertinent Negatives