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Modified Sharp Purser Test

This is a test for upper Cervical Spine instability. The test assess for the integrity of the Transverse longitudinal ligament that prevents C1 on C2 displacement in an anterior direction during cervical flexion, which prevents spinal cord compression. In order to execute the test first ask the patient to forward flex the head and assess for symptoms. Note any myelopathic symptoms. Next, Stabilize C2 with a pincher grasp and then apply an Anterior to posterior force thru the forehead to relocate C1 on C2 while assessing for excessive movement “laxity” and symptom response. A positive test is identified as symptom reproduction during forward flexion and/or decreased symptoms following relocation of the head in an anterior to posterior direction, and/or excessive laxity.

Uitvlugt & Indenbaum et. al. 1988

Sn: 69

Sp: 96

+ LR: 17.3

This test appears to have high clinical utility when attempting to identify upper cervical spine instability. It’s recommended that this test be utilized whenever myelopathic symptoms are reported, following MVA (Motor Vehicle Accident), diagnosis of Trisomy 21 “Down Syndrome”, and is best utilized at the beginning of the examination.