Clinical assessment of atlantoaxial instability using the sharp‐purser test

Uitvlugt, Gregory; Indenbaum, S

doi:10.1002/art.1780310715

Cited by 59 publications

(18 citation statements)

References 19 publications

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“…The Delphi survey participants did not reach consensus for a "positive ligament shear test," a "positive test for transverse ligament of atlas," a "positive Alar Ligament Stress Test," "positive (vertebrobasilar insufficiency) VBI tests," and a "positive Sharp-Purser Test." Although the Sharp-Purser test has been found to be a valid indicator 73,74 for detection of radiographic instability, this method was not consensually chosen as an identifier for CCSI.…”

Section: Proposed Identifiers For Physical Examination Findingsmentioning

confidence: 99%

Identifiers Suggestive of Clinical Cervical Spine Instability: A Delphi Study of Physical Therapists

et al. 2005

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Background and Purpose Clinical cervical spine instability (CCSI) is controversial and difficult to diagnose. Within the literature, no clinical or diagnostic tests that yield valid and reliable results have been described to differentially diagnose this condition. The purpose of this study was to attempt to obtain consensus on symptoms and physical examination findings that are associated with CCSI. Subjects One hundred seventy-two physical therapists who were Orthopaedic Certified Specialists (OCS) or Fellows of the American Academy of Orthopaedic Manual Physical Therapists (FAAOMPT) participated in the survey. Methods This study was a 3-round Delphi survey designed to obtain consensual symptoms and physical examination findings for CCSI. Results The symptoms that reached the highest consensus among respondents were “intolerance to prolonged static postures,” “fatigue and inability to hold head up,” “better with external support, including hands or collar,” “frequent need for self-manipulation,” “feeling of instability, shaking, or lack of control,” “frequent episodes of acute attacks,” and “sharp pain, possibly with sudden movements.” The physical examination findings related to cervical instability that reached the highest consensus among respondents included “poor coordination/neuromuscular control, including poor recruitment and dissociation of cervical segments with movement,” “abnormal joint play,” “motion that is not smooth throughout range (of motion), including segmental hinging, pivoting, or fulcruming,” and “aberrant movement.” Discussion and Conclusion The Delphi method is useful in situations where clinical judgments are encountered but empirical evidence to provide evidence-based decision making does not exist. Findings of this study may provide beneficial clinical information, specifically when the identifiers are clustered together, because no set of clinical examination and symptom standards for CCSI currently exists. Diagnosis of CCSI is challenging; therefore, appropriate clinical reasoning is required for distinctive physical therapy assessment using pertinent symptoms and physical examination findings.

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Section: Proposed Identifiers For Physical Examination Findingsmentioning

confidence: 99%

Identifiers Suggestive of Clinical Cervical Spine Instability: A Delphi Study of Physical Therapists

et al. 2005

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“…Suboccipital pain, torticollis, and external support of the head have all been noted in the literature as red flags for upper cervical instability. [20][21][22] Therefore, the initial physical therapy examination focused on the upper cervical spine and possible precautions to treatment, rather than the prescribed interventions for a suspected rotator cuff tear. Palpation revealed significant tenderness and increased muscle tone along the left SCM, levator scapulae, upper trapezius, and scalene musculature.…”

Section: Examinationmentioning

confidence: 99%

Upper cervical instability associated with rheumatoid arthritis: a case report

Cunningham

2016

Journal of Manual & Manipulative Therapy

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Rheumatoid arthritis (RA) affects between 1 and 2 million individuals in the United States. Atlantoaxial instability (AAI) has been shown to have 40-85% prevalence among individuals with RA. Despite the high incidence of craniovertebral involvement, overt symptoms of instability are rare. The high risk of AAI and limited symptomology should increase therapist suspicion of potential contraindications and precautions to initiation of therapy for the cervical spine without prior diagnostic imaging. The purpose of this case study is to describe the historical, clinical, and diagnostic imaging complexity of AAI associated with RA, and to illustrate the use of these factors in the clinical reasoning within a patient case.

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“…The test has demonstrated a sensitivity of 0.69, a specificity of 0.96, and positive and negative likelihood ratios of 17.25 and 0.32, respectively, when compared with a radiographic reference standard in patients with rheumatoid arthritis. 57 The lateral shear test screens for the integrity of the alar ligaments in the frontal plane. It is performed with the patient lying supine, while the examiner places the metacarpophalangeal joint of the second digit against the transverse process of the atlas on one side and the metacarpophalangeal joint of the second digit of the contralateral hand on the transverse process of the axis on the opposite side.…”

Section: Diagnostic Considerationsmentioning

confidence: 99%