What is a positive spurring sign indicative of?

Spurling Sign: Diagnostic Indicator for Cervical Radiculopathy

A positive Spurling sign indicates cervical nerve root compression or cervical radiculopathy, with high diagnostic accuracy for identifying patients who require further imaging studies. 1

Clinical Significance and Diagnostic Performance

• The Spurling test demonstrates 95% sensitivity and 94% specificity for detecting nerve root pathology when correlated with imaging studies (CT and/or MRI). 1

• Patients with a positive Spurling test have a high probability of nerve root compression and should be sent for further imaging studies, while those with a negative test make nerve root pressure less likely. 1

Test Methodology and Interpretation Challenges

Despite its diagnostic value, significant inconsistency exists in clinical practice regarding how the test is performed and interpreted:

• No single testing method is preferred by more than 37% of physical therapists, with ipsilateral lateral flexion, rotation, and extension with compression being most common (37%), followed by ipsilateral lateral flexion with compression alone (32%). 2

• A critical interpretation error occurs when 67% of practitioners consider proximal symptom provocation alone (without distal radiating symptoms) as a positive test. 2 This represents a misunderstanding of what constitutes true radiculopathy versus local cervical pain.

• Practitioners rate the Spurling test as having only moderate to low value toward diagnosis/classification and treatment decisions, despite its objectively high diagnostic accuracy. 2

Clinical Application Algorithm

For patients presenting with neck and arm symptoms:

1. Perform the Spurling test using compression with ipsilateral lateral flexion and rotation 2

2. Interpret as positive ONLY if distal radiating symptoms into the upper extremity are reproduced (not just local neck pain) 2

3. If positive: Proceed directly to imaging studies (MRI or CT) to confirm nerve root pathology 1

4. If negative: Nerve root compression is unlikely, and alternative diagnoses should be considered 1

Critical Pitfalls to Avoid

• Do not interpret proximal pain provocation alone as a positive test - this leads to false positives and unnecessary imaging 2

• Do not dismiss the test's value based on perceived low utility - objective data shows 95% sensitivity and 94% specificity when properly performed and interpreted 1

• Do not use inconsistent methodology - standardize your technique to improve diagnostic reliability 2

The Spurling sign remains a highly valuable clinical tool when properly executed and interpreted, serving as an effective screening mechanism to identify patients requiring advanced imaging for suspected cervical radiculopathy.