Sharp-Purser test is a cervical spine examination procedure that tests for possible orthopaedic subluxation of the Atlas that has reduced. This test assesses the stability of the Atlanto-Axial joint and stabilizers of the dens of Atlas. It specifically assesses the integrity of the Transverse ligament. Instability of the Atlantoaxial joints is a hallmark complication of rheumatoid arthritis in the cervical spine.


Patient should be awake and cooperative to perform the Sharp-Purser test.

  1. Patient should be seated during the examination.
  2. The examiner stabilizes the patient’s head with his hand over the patient’s forehead.
  3. The examiner uses his thumb on his other hand over the spinous process of C2 (axis).
  4. The patient flexes her head forward as the examiner applies gentle A-P pressure on the patient’e’ forehead.
  5. The examiner checks for the patient’s head sliding backwards or unusual noises while performing the motion.

Examiner holds patient’s head with one hand over the forehead and the other thumb over the spinous process of C2.


Positive Sharp-Purser Test

There is a positive Sharp-Purser test when the patient’s head slides backwards during the procedure and/or a “clunk” with motion. These signs could indicate orthopaedic subluxation of the Atlas that has reduced.

Clinical Notes

Examiners should perform the Sharp-Purser test with extreme caution because there are sensitive structures along the area. If there is suspected subluxation or a positive test result, diagnostic imaging must be done. Radiographs of the cervical flexion and extension views should be done ASAP.