What is Spurling's Test?
Spurling's test is a provocative cervical spine maneuver used to diagnose cervical radiculopathy by narrowing the neural foramina through neck extension combined with lateral bending (and sometimes rotation) toward the symptomatic side, followed by axial compression applied to the top of the patient's head. 1, 2
How the Test is Performed
The test involves positioning the patient's neck in extension with lateral bending toward the side of suspected radiculopathy, then applying downward pressure on top of the head to further compress the neural foramina. 1, 2 The test is considered positive when it reproduces radicular pain or tingling that starts in the shoulder and radiates distally to the elbow or beyond in a dermatomal distribution. 1, 2
Optimal Technique Based on Evidence
The most effective maneuver consists of extension and lateral bending first, followed by axial compression if initial findings are inconclusive. 1 This staged approach is recommended because:
- Extension with lateral bending and axial compression produced the highest pain scores (mean VAS 7) and most distal pain radiation (mean 2.5 on a 0-3 scale) 1
- Adding rotation to extension and compression caused the highest paresthesia levels but was least tolerable, requiring test discontinuation in some cases 1
- A staged approach balances diagnostic yield with patient tolerability 1
Diagnostic Performance
Specificity vs. Sensitivity Trade-off
Spurling's test is highly specific (92-99%) but has low to moderate sensitivity (31-67%), making it better suited for confirming cervical radiculopathy rather than screening for it. 3, 4
The most recent meta-analysis from 2025 found: 3
- Pooled sensitivity: 53% (95% CI: 0.29-0.78)
- Pooled specificity: 92% (95% CI: 0.88-0.96)
- Positive likelihood ratio: 3.28
- Negative likelihood ratio: 0.28
Factors Affecting Diagnostic Accuracy
Sensitivity varies significantly based on: 3
- Reference standard used: Imaging as reference yields 67% sensitivity vs. electrodiagnostic testing at 31% 3
- Maneuver modifications: Adding neck rotation or extension increases sensitivity to 67% compared to 31% without these components 3
Clinical Context and Limitations
When Physical Examination Has Limited Correlation with Imaging
A recent meta-analysis concluded there is limited evidence for correlation between physical examination findings (including Spurling's test) and MRI evidence of cervical nerve root compression. 5 This may be due to high rates of both false-positive and false-negative MRI findings in suspected cervical radiculopathy. 5
Common Pitfall to Avoid
Do not rely on Spurling's test alone to rule out cervical radiculopathy given its low sensitivity—a negative test does not exclude the diagnosis. 3, 4 The test is most valuable when positive, as its high specificity makes it useful for confirmation. 3
Practical Clinical Application
Use Spurling's test as part of the clinical assessment for cervical radiculopathy, but recognize that imaging is not required at initial presentation without red flags, as 75-90% of cases resolve with conservative treatment. 6, 7 The test helps identify patients who may benefit from activity modification, such as avoiding neck hyperextension positions (e.g., salon sink shampooing) that can exacerbate symptoms. 2