From the Research
The Spurling test is a physical examination maneuver used to diagnose cervical radiculopathy, which is compression or irritation of nerve roots in the neck, and it is performed by extending the patient's neck, rotating and laterally bending the head toward the symptomatic side, and then applying downward pressure on the top of the head, with a positive test occurring when this maneuver reproduces or worsens the patient's radiating arm pain, numbness, or tingling 1. To perform the test, the examiner extends the patient's neck, rotates and laterally bends the head toward the symptomatic side, and then applies downward pressure on the top of the head. The test works by narrowing the neural foramen (the opening where nerve roots exit the spine), which increases compression on an already irritated nerve root. While the Spurling test is highly specific (meaning a positive result strongly suggests cervical radiculopathy), it has lower sensitivity, so a negative result doesn't necessarily rule out the condition, as shown in a study that found the test had a sensitivity of 30% and a specificity of 93% 2. This test is particularly useful in clinical settings as it requires no special equipment and can quickly provide valuable diagnostic information when evaluating patients with neck pain that radiates into the arm, and it can help confirm a diagnosis of cervical radiculopathy, with a study finding that patients with positive Spurling test have probable nerve root pressure and should be sent for further imaging studies 3. Some key points to consider when performing the Spurling test include:
- The test should be performed gently and carefully to avoid causing unnecessary discomfort or injury to the patient
- The test should be performed on both sides of the neck to compare the results and determine if there is any difference in the patient's symptoms
- The test should be used in conjunction with other diagnostic tests, such as imaging studies and electromyography, to confirm a diagnosis of cervical radiculopathy
- The test has been shown to be useful in helping to confirm a cervical radiculopathy, but it is not useful as a screening test due to its low sensitivity 2. Overall, the Spurling test is a useful tool for diagnosing cervical radiculopathy, but it should be used in conjunction with other diagnostic tests and a thorough physical examination to confirm a diagnosis.