Sharp Purser Test | Transverse Ligament Integrity
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- Опубликовано: 8 апр 2018
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The Sharp Purser test tests the integrity of the transverse ligament which keeps the dens of C2 in place against the neural arch of C1.
📚 ARTICLES: Hutting et al. (2013): www.ncbi.nlm.nih.gov/pubmed/2...
Uitvlugt et al. (1988): www.ncbi.nlm.nih.gov/pubmed/3...
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This is not medical advice! The content is intended to be educational only for health professionals and students. If you are a patient, seek care of a health care professional.
Open mouth lateral flexion radiographs are a good imaging option to further evaluate for craniocervical junction instability.
easy to understand , with evidence provided ... great job .. helped alot before my manual therapy exam .. and can you please include spine mobilization techniques ?
Glad it helped! We are on it 😉
Gangsta got shot he's not a problem anymore 😭
thank you!
I have mild spondylitis straightening of cervical spine lordosis misalignments in c1cc2 c3 c4
Would you still perform this test if the patient does not complain of sx in flexion? Could this be a method of ruling it out or should we go to the provocative test?
Thank you kai
Pincer is sharp from the top and from the bottom it's curve so it's half an egg, which connects to the top egg from blaksley mews
Thanks Guys!!!
No worries Jared!
Looks like a very aggressive mulligan concept headache snag, lol
Baja prevalencia 🤔, aplicar reglas canadienses para eliminar posible fx cervical.
I think this test need critical visual imagination of inner structures to comprehend and apply. Thanks a lot
glad you liked the video!
@@Physiotutors i think atlas anterior glide is recomended not axis anterior glide
HI Guys, great video, I was wondering if I did suspect someone of having cranial vertebral instability would I refer to the doctor right away and wait for their opinion of conservative or non conservative management?
In case you suspect it refer out to neurologist
Thanks for the video :) I have a question you could might help me with...what is the difference between the Sharp Purser and the Modified Sharp Purser test? Thank you :)
The original description by Sharp was just active upper cervical flexion by the patient which elicits symptoms, possibly with gentle overpressure into flexion by the examiner. So it's a symptom provocation test instead of a reduction test. It's basically the first part of the modified sharp-purser test that we are showing.
We didn't call it "modified" because the original test is not really performed as stand-alone test anymore.
you describe the mechanism by which this stresses the transverse ligament being due to an anterior to posterior movement of C1 on C2 but if you are securing the forehead and pushing the spinous process of C2 posterior to anterior then as far as I can see all this woud do is push the anterior aspect of the dens of C2 into the posterior aspect of the anterior arch of C1 which would place no anatomical stress on the transverse ligament at all. The mechanism you propose can surely only be correct if you were contacting the transverse processes of C1 and challenging them in a posterior to anterior direction whilst stabilising the skull. - can you explain?
Yes I also agree with you
Interesting. My neck clunks with extension and flexion. Always has. I've never come across someone else whose neck does this. I have recently been diagnosed with hypermobile eds. And I have been referred to a neurologist who has experienced with eds.
How are you now?
@@Rahul_Arya321 thanks for asking. I'm managing. My dynamic MRI was only borderline CCI but instability from c2 to c6, and I probably have AAI and I need to get a CT with rotation. I think I have CCI and maybe I was tucking my chin too much during MRI, I don't know. My surgeon doesn't necessarily want to operate though because many people are still sick after surgery. I've never had a doctor in or physical therapist really look at my neck or do a sharp purser test.
@@zenzebra2801 Oh I see.... Do you have what's app? I just want to know that I have any problems in my neck and I'll send a viedo of my mobile neck. 🤦♀️😔
Question: Since this is a provocative test the therapists hand behind the head should be placed on the spinous process of the atlas to translate the atlas anteriorly and thereby stress the transverse ligament, or am I incorrect?
It's not a provocation but a reduction test. That's why you reduce the distance between the atlas and the dens by pushing C2 anteriorly.
@@Physiotutors Got it, thank you
I have always felt this test is similar to the VBI, if i'm worried about that level of instability or risk, i'd be terrified to do the test.
It's a relief test, so the test should actually ease symptoms in case of a high cervical instability.
big thumb up
Appreciate it!
What's the difference between sharp Purser test and transverse ligament stress test?
The Sharp Purser Test is a relief test as the atlas and the dens are approximated thus reducing provocation.
The Transverse ligament stress test does exactly the opposite. It moves the atlas anteriorly, so the dens is moved towards the dura which can lead to symptoms if the transverse ligament is ruptured.
@@Physiotutors Thank you!
at minute 2:25 you say that the posterior translation of the occiput and atlas will increase the symptoms and create a positive test. But wouldn't the symptoms actually decrease by the posterior translation if the transverse ligament is "damaged"? So a decrease of the symptoms would create a positive test? Would be very thankful for an answer :) Great videos by the way!
nevermind, you said decrease not increase haha
nice illustration
thanks, Adrian happy you like it!
My physio suspects that I have severe upper cervical instability and has referred me to see if we can get an MRI or something, but that image really helps me understand what could be happening to cause all the neurological side of things that I’m experiencing.
Thanks (though I’m deeply concerned! Only 28, no inciting events, wtf?!)
@@MzyraJ What were your symptoms if you don't mind me asking
@@kylelisowe9316 oh man, so many things. Seizures for one thing, which can be triggered by bad head positions. Loads of other neurological stuff and weakness and fatigue.
Unfortunately the MRI was not helpful and my research has shown me there's like a bajillion different neurological conditions with a crazy amount of overlap on symptoms, so all I know is my neurological system is screwed and all I can am given is painkillers :))))