From the Guidelines
The Spurling test is a physical examination technique used to diagnose cervical radiculopathy, which is compression or irritation of nerve roots in the neck, as described in the context of assessing cervical neck pain or cervical radiculopathy 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.
- A positive test occurs when this maneuver reproduces or worsens the patient's radiating arm pain, numbness, or tingling.
- This happens because the movement narrows the neural foramen (the opening where spinal nerves exit), compressing the affected nerve root and reproducing symptoms.
- The Spurling test is highly specific but not very sensitive, meaning a positive result strongly suggests cervical radiculopathy, but a negative result doesn't rule it out, as noted in the assessment of physical examination tests in the setting of a clinical history of cervical radiculopathy 1. This test is typically part of a comprehensive neurological examination that includes assessment of reflexes, strength, and sensation.
- Patients with severe neck pain, known trauma, or signs of spinal cord compression should not undergo this test as it could potentially worsen their condition, highlighting the importance of considering red flag symptoms in the evaluation of cervical neck pain or cervical radiculopathy 1.
From the Research
Definition of Spurling Test
- The Spurling test is a diagnostic maneuver used to assess cervical radiculopathy, which is a condition that affects the nerves in the cervical spine 2.
- The test was first described by Spurling and Scoville in 1944 and has since been modified to improve its diagnostic value 2.
Application of the Spurling Test
- The test involves a combination of extension, lateral bending, and axial compression of the cervical spine to reproduce the patient's symptoms 2.
- The test can be modified to include rotation and axial compression, which can elicit paresthesia and pain in patients with cervical radiculopathy 2.
Diagnostic Value of the Spurling Test
- The Spurling test has been shown to be a useful diagnostic tool for cervical radiculopathy, with a high sensitivity and specificity 2.
- The test can be used in combination with other diagnostic tests, such as electromyography (EMG) and magnetic resonance imaging (MRI), to confirm the diagnosis of cervical radiculopathy [(3,4,5,6)].