Spurling Test: Performance, Interpretation, and Clinical Application
Test Performance
The Spurling test is performed by positioning the patient's cervical spine in extension and ipsilateral lateral bending toward the symptomatic side, followed by axial compression applied to the top of the head. 1
Optimal Testing Technique
Extension + lateral bending + axial compression produces the highest pain intensity (mean VAS 7) and most distal symptom radiation (mean 2.5 on a 0-3 scale). 1
An alternative technique using extension + rotation + axial compression generates the highest paresthesia levels but is less tolerable, causing test discontinuation in some patients. 1
A staged approach is recommended: begin with extension and lateral bending, then add axial compression if initial findings are inconclusive. 1 This minimizes patient discomfort while maintaining diagnostic utility.
Substantial variation exists in clinical practice, with no single method preferred by more than 37% of physical therapists surveyed, indicating widespread inconsistency in test application. 2
Test Interpretation
Positive Test Criteria
A positive Spurling test requires pain or tingling that originates in the shoulder and radiates distally to at least the elbow. 3
Proximal symptom provocation alone (neck or shoulder pain without distal radiation) should NOT be interpreted as positive, despite 67% of surveyed clinicians incorrectly considering this positive. 2
The test demonstrates high specificity (93-95%) but low sensitivity (30%) for cervical radiculopathy confirmed by electrodiagnostic testing. 3, 4
Negative Test Interpretation
A negative test does not rule out cervical radiculopathy given the low sensitivity of 30%. 3
The test is not useful as a screening tool but rather serves to confirm suspected radiculopathy when clinical suspicion already exists. 3
Clinical Utility
The Spurling test functions as a confirmatory rather than screening examination—when positive alongside consistent history and physical findings, it strongly suggests cervical radiculopathy. 5
Diagnostic Performance by Clinical Context
Positive results occur in only 16.6% of patients with normal findings, 3.4% with non-radicular nerve disorders, 37.5% with possible radiculopathy, and 40% with certain radiculopathy. 3
The test demonstrates 92% sensitivity and 95% specificity with 96.4% positive predictive value specifically for soft lateral cervical disc prolapse when compared against surgical or MRI findings. 4
High positive predictive value (96.4%) can improve the yield of MRI examinations by better selecting patients likely to have positive imaging findings. 4
Contraindications and Precautions
Avoid testing in patients with suspected cervical spine instability, acute trauma, or severe myelopathy, as axial compression could theoretically worsen neural compression (general medical knowledge).
Discontinue the test immediately if severe symptoms are provoked or the patient cannot tolerate the maneuver. 1
The test was discontinued on three occasions in one study due to intolerable symptom provocation with the extension-rotation-compression variant. 1
Common Pitfalls
Misinterpreting proximal-only symptoms as positive is the most prevalent error, occurring in two-thirds of practitioners surveyed. 2
Inconsistent methodology undermines test reliability and comparison across examiners—standardization of technique is essential. 2
Over-reliance on the test alone without considering the complete clinical picture leads to diagnostic errors given its low sensitivity. 3
Clinicians rate the Spurling test as having moderate to low value for diagnosis and treatment planning, suggesting it should supplement rather than drive clinical decision-making. 2