Sharp-Purser Test

Sharp-Purser Test

Purpose of Test: The Sharp-Purser test assesses the integrity of the transverse ligament by testing atlantoaxial stability.

It is crucial to screen the upper cervical ligaments when there is a question of cervical trauma.

Step 1: 0:42 With patient sitting upright, palpate to find the C2 spinous process and stabilize it using the web space of your hand.

Step 2: 0:59 Flex the patient’s head to approximately 30 degrees. Place your other hand on the patient’s forehead. With your forearms parallel to the ground, deliver a posteriorly directed force through the patient’s forehead while stabilizing C2.

A positive test is indicated by the head sliding posteriorly relative to C2, an audible/palpable “clunk”, and/or a REDUCTION of neurological symptoms.

A positive Sharp-Purser indicates atlantoaxial instability due to decreased integrity of the transverse ligament and requires medical attention.

“Because the Sharp-Purser Test is considered an alleviation maneuver, it may be safer than the [other transverse ligament tests] but potentially less reliable because it is not intended to reproduce symptoms. The Sharp-Purser test was found to have a positive predictive value of 85%, a specificity of 96%, and a sensitivity of 88% in subjects with rheumatoid arthritis when subluxation was greater than 4 mm.” Wise and Shenk, 2011.

Evidence:

Wise and Shenk, 2011 ISC 21.1.5 pp. 19-21
IFOMPT Cervical Screening Document