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 axis. 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 any atlantoax subluxation caused by forward cervical flexion of an unstable spine.
Evidence[edit | edit source]
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.
Resources[edit | edit source]
add any relevant resources here
References
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