The Spurling test is a specialized maneuver used in orthopedic and neurological physical examinations to help determine the source of a patient’s neck and arm pain. This diagnostic tool is employed by healthcare providers when symptoms suggest a nerve issue originating in the neck. It is a provocative test, meaning its purpose is to intentionally reproduce the patient’s specific discomfort to isolate the anatomical structure responsible for the pain. The test provides objective information that helps guide the subsequent diagnostic process.
What the Spurling Test Measures and How It Is Performed
The objective of the Spurling test is to mechanically decrease the space available for a cervical nerve root as it exits the spinal column. Each nerve root passes through a bony channel called the neural foramen, and narrowing this opening attempts to compress the nerve root and provoke symptoms. This maneuver is performed with the patient seated.
The examination starts by positioning the patient’s head in a combination of lateral bending and extension toward the side of the reported arm pain. This specific neck posture naturally reduces the diameter of the neural foramen, placing initial stress on the nerve root. If this initial positioning does not reproduce the symptoms, the clinician proceeds to the next, more provocative step. The final component involves applying a gentle, downward axial compression force to the top of the patient’s head. This combination of bending, extension, and compression further decreases the space and increases mechanical irritation on the nerve root.
Interpreting a Positive Result
The Spurling test is considered positive only if the maneuver successfully reproduces the patient’s specific radicular symptoms. These symptoms travel away from the neck and down the arm, typically including radiating pain, tingling, or numbness that follows the distribution of a particular nerve root (dermatome). Reproducing this distinct, shooting pain is the definitive indicator of a positive result.
A negative result occurs if the patient experiences no change in symptoms or reports only localized pain in the neck. Localized neck pain indicates that the compression is likely irritating joint structures, such as the facet joints, but not the nerve root itself. The high specificity of a positive test means that reproducing the radiating pain strongly confirms nerve root involvement.
The Underlying Cause: Cervical Radiculopathy
A positive Spurling test is a strong clinical indicator of a condition known as cervical radiculopathy, which is the medical term for a “pinched nerve” in the neck. This condition occurs when a nerve root in the cervical spine is compressed, irritated, or inflamed. The mechanical narrowing of the neural foramen during the test recreates this impingement, causing the characteristic radiating pain.
The structural causes of compression are typically age-related changes and disc issues. In younger individuals, a herniated intervertebral disc is often the primary culprit, where the soft inner material pushes out and physically presses on the adjacent nerve root. This disc material can also release inflammatory chemicals that further irritate the nerve.
For older adults, degenerative changes are more frequently responsible for the nerve compression. These changes include the formation of bone spurs, or osteophytes, which develop as the spine ages. These bony growths, along with a decrease in the height of the discs, reduce the dimensions of the neural foramen, leading to chronic nerve root impingement. This structural narrowing is a component of cervical spondylosis, a general term for wear-and-tear of the neck joints.
Next Steps After Diagnosis
A positive Spurling test provides a high degree of clinical suspicion for cervical radiculopathy, but a definitive diagnosis requires further investigation. The next step typically involves obtaining diagnostic imaging to visualize the specific anatomical structures causing the compression. Magnetic Resonance Imaging (MRI) is often the preferred tool, as it provides detailed images of soft tissues, such as intervertebral discs and nerve roots.
A Computed Tomography (CT) scan may also be ordered, particularly if the clinician needs a clearer view of the bony structures, such as to confirm the presence of significant bone spurs or foraminal stenosis. These imaging results correlate the physical exam findings with the underlying structural pathology, confirming the exact location and nature of the nerve compression.
Initial treatment for cervical radiculopathy is generally conservative and non-surgical, focusing on symptom relief and restoring function. This commonly includes a course of physical therapy to improve neck strength, posture, and mobility. Anti-inflammatory medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), are often prescribed to manage the pain and reduce inflammation around the irritated nerve root. Activity modification, which involves avoiding positions or activities that exacerbate the radiating pain, is also an important part of the early management plan.