Скачать или смотреть Anterior Shear Test (Seated)

Assesses for atlantoaxial instability via evaluation of the transverse ligament.

Indication:
Atlantoaxial instability
Subluxation of the atlas (C1) on the axis (C2)

Technique:
Patient Position
Seated

Examiner Position
Standing beside the patient

Steps Of Performance
1. Have the patient perform slight cervical retraction, achieving approximately 20-30 degrees of cervical flexion
Note: before continuing, assess for any symptoms of numbness and/or tingling of the upper extremities
2. Place the palm of one hand on the patient’s forehead, while the other hand stabilizes the spinous process of the C2 vertebrae (axis) with a pincer grip
Ensure both of the patient’s arms are left hanging parallel to the ground
3. The hand located on the patient’s forehead applies an anterior to posterior force

Mechanism:
Laxity, damage, or dysfunction of the transverse ligament (which maintains the position of the odontoid process relative to C1) can cause subluxation of C1 onto C2 during cervical flexion. The dens of C2 may compress the tracts of the spinal cord during subluxation (anterior shear) producing myelopathic symptoms such as numbness, weakness, paresthesia, and/or pain in the extremities.

Interpretation:
Positives
Anterior to posterior sliding movement
Antlantoaxial instability
Note: A to P sliding movement is often accompanied by an audible “clunk” indicating reduced subluxation of the atlas
Reduced myelopathic symptoms
Brain stem/spinal cord pressure has been reduced

References:
Mansfield CJ, Domnisch C, Iglar L, Boucher L, Onate J, Briggs M. Systematic review of the diagnostic accuracy, reliability, and safety of the sharp-purser test. J Man Manip Ther. 2020;28(2):72-81. doi:10.1080/10669817.2019.1667045

Magee DJ, Manske RC. Orthopedic Physical Assessment. St. Louis, MO: Elsevier; 2014.

Reiman MP. Orthopedic clinical examination. Champaign (IL): Human kinetics; 2015.

Mansfield CJ. Cervical myelopathy causing numbness and paresthesias in lower extremities: A case report identifying the cause of a false positive Sharp-Purser test. Physiother Theory Pract. 2019;35(4):401-408. doi:10.1080/09593985.2018.1443361

Stevens JC, Cartlidge NE, Saunders M, Appleby A, Hall M, Shaw DA. Atlanto-axial subluxation and cervical myelopathy in rheumatoid arthritis. Q J Med. 1971;40(159):391-408.

Uitvlugt G, Indenbaum S. Clinical assessment of atlantoaxial instability using the Sharp-Purser test. Arthritis Rheum. 1988;31(7):918-922. doi:10.1002/art.1780310715

Mathews JA. Atlanto-axial subluxation in rheumatoid arthritis. Ann Rheum Dis. 1969;28(3):260-266. doi:10.1136/ard.28.3.260

Forrester G, Barlas P. Reliability, and validity of the Sharp-Purser test in the assessment of atlanto-axial instability in patients with rheumatoid arthritis. Physiotherapy. 1999;85(7):376

Katayama M. Clinical and radiological evaluation of the spine due to rheumatoid arthritis. Bull Yamaguchi Med Sch. 1990;37(1–2PG–31–43):31–43.