Transcript Document

Cervicogenic Headache: Special
Examination Maneuvers
Eric R Helm, M.D.
Assistant Professor
Department of PM&R
Division of Sports & Spine Rehab
Sharp-Purser test
• Placing one hand over the
patient’s forehead, while the
thumb of the opposite hand is
placed over the C2 spinous
process for stabilization.
• The patient is asked to flex the
head on the neck, while you
apply a posteriorly directed force
on the forehead.
• A positive test is indicated if there
is backward movement of the
head, which may be accompanied
by a “clunk.”
– The backward movement indicates
that the subluxation of C1,
produced by forward flexion of the
neck, has been reduced.
Lateral Shear test
• Patient lying supine.
• The metacarpophalangeal (MCP)
joint of digit 2 is placed against
the transverse process of the
atlas on one side and the MCP of
digit 2 from contralateral hand is
placed on the transverse process
of axis on the opposite side.
• The two MCP joints are pushed
towards one another, creating a
shear force of C1 on C2.
– The test is considered positive if
you feel an increased transitory
“shift” between the 2 bones or
patient symptoms provoke by the
maneuver.