What is the Spurling maneuver?

What is the Spurling Maneuver?

The Spurling maneuver (also called the Spurling test) is a provocative physical examination technique used to diagnose cervical radiculopathy by reproducing radicular symptoms through cervical spine extension, lateral bending toward the affected side, and axial compression of the head. 1, 2

Historical Context

The Spurling maneuver was first described in 1944 by Spurling and Scoville as part of their work on posterior surgical approaches to the cervical spine for treating herniated cervical discs. 3

How to Perform the Test

Basic Technique

• The examiner extends the patient's neck, laterally bends it toward the symptomatic side, and applies axial compression (downward pressure) on top of the patient's head. 1, 4

Optimal Technique Based on Evidence

• A maneuver consisting of extension, lateral bending, and axial compression produces the highest pain intensity scores and most distally elicited pain, making it the most effective variation. 4
• When cervical radiculopathy is suspected, perform extension and lateral bending first, then add axial compression if the initial maneuver produces inconclusive results. 4
• The test can be performed with several variations, including extension with rotation and axial compression, which produces the highest paresthesia levels but may be less tolerable to patients. 4

Interpretation of Results

Positive Test Criteria

• The test is considered positive if it reproduces pain or tingling that starts in the shoulder and radiates distally to the elbow or beyond. 5
• A positive test indicates probable nerve root compression and warrants further imaging studies. 2

Diagnostic Accuracy

• The Spurling test has high specificity (93-94%) but low sensitivity (30%) for cervical radiculopathy diagnosed by electrodiagnostic studies. 5, 2
• One study reported much higher sensitivity (95%) and specificity (94%) when correlated with imaging studies (CT/MRI) rather than electrodiagnostic testing. 2
• The test has a positive predictive value suggesting it is clinically useful for confirming cervical radiculopathy, but its low sensitivity means a negative test does not rule out the diagnosis. 5

Clinical Utility

When to Use

• Use the Spurling test along with the shoulder abduction test and upper limb tension test to confirm the diagnosis of cervical radiculopathy in patients presenting with neck and arm pain. 1
• The test is most useful for confirming a suspected diagnosis rather than screening, given its high specificity but low sensitivity. 5

What Happens After a Positive Test

• Patients with a positive Spurling test should be sent for imaging studies (MRI or CT) to identify the specific pathology causing nerve root compression. 2
• Most cases of cervical radiculopathy resolve with conservative treatment regardless of intervention type, so patients should be reassured. 1

Important Caveats

Contraindications and Precautions

• Exercise caution when performing this test in patients with significant vascular disease, cervical stenosis, severe kyphoscoliosis, limited cervical range of motion, Down syndrome, severe rheumatoid arthritis, cervical radiculopathies with severe symptoms, Paget's disease, ankylosing spondylitis, low back dysfunction, spinal cord injuries, or morbid obesity. 3
• The maneuvers involving extension, rotation, and axial compression may be poorly tolerated and can cause discontinuation of the examination. 4

Limitations

• There is significant variation in how the Spurling test is described and performed across different studies, with poor uniformity in diagnostic criteria for cervical radiculopathy in the literature. 6
• The test's sensitivity varies depending on whether electrodiagnostic studies or imaging is used as the reference standard. 2, 5