Instability in the cervical spine is most commonly the result of ligament damage (e.g., transverse ligament, alar ligaments), bone or joint damage (e.g., fracture or dislocation) or weak muscles (e.g., deep flexors or extensors). The instability may be the result of chronic arthritic conditions (e.g., rheumatoid arthritis), trauma, long-tem corticosteroid use, congenital malformations, Down syndrome, and osteoporosis.1 One commonly should have a high level of spuspicion of instability if in the history, the patient complains of instability, a lump in the throat, lip paresthesia, severe headache (espcially with movement), muscle spasm, nausea, or vomiting.1
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Sharp-Purser Test. This test should be performed with extreme caution. It is a test to determine subluxation of the atlas on the axis. If the transverse ligament that maintains the position of the odontoid process relative to C is torn, C1 will translate forward (sublux) on C2 on flexion. Thus, the examiner may find the paient reticent to do forward flexion if the transverse ligament has been damaged.
Hoe doe ik de test?
The examiner places on hand over the patient's forehead while the thumb of the other hand is placed over the spinous process of the axis to stabilize it. The patient is asked to slowly flex the head; while this is occurring, the examiner presses backward with the palm.
- A positive test is indicated if the examiner feels the head slide backward during the movement. The slide backward indicates that subluxation of the atlas has been reduced, and the slide may be accompied by a 'clunk'
Transverse Ligament Stress Test.91,101 The patient lies supine with the examiner supporting the occiput with the palms and the third, fourth, and fifth fingers. The examiner places the index fingers in the space between the patient's occiput and C2 spinous process so that the fingertips are overlying the neural arch of C1. The head and C1 are then carefully lifted anteriorly together, allowing no flexion or extension. This anterior shear is normally resisted by the transverse ligament. The position is held for 10 to 20 seconds to see wether symptoms occur, indicating a positive test.
-Positive symptoms include soft end feel; muscle spasm; dizziness; nausea; paresthesia of the lip, face, or limb; nystagmus; or a lump snesation in the throat. The test insdicates hypermobility at the atlantoaxial articulation.
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