The Spurling’s test is a diagnostic procedure used to evaluate neck pain and related symptoms. It helps healthcare providers assess conditions affecting the cervical spine, or neck, and its nerves. This test guides further diagnostic steps and treatment plans.
What is the Spurlings Test?
The Spurling’s test is a physical examination technique designed to identify issues within the cervical spine, especially nerve compression. Its purpose is to provoke symptoms of nerve root irritation or compression in the neck. The test is typically performed with the patient seated or standing.
During the procedure, a healthcare provider gently positions the patient’s head, tilting it towards the symptomatic side with slight extension or rotation. Gentle downward pressure is then applied to the top of the head. This maneuver aims to narrow the spaces where nerve roots exit the spinal cord, potentially reproducing the patient’s discomfort.
Understanding a Positive Result
A “positive” Spurling’s test indicates the maneuver reproduced or intensified the patient’s symptoms. This suggests cervical radiculopathy, commonly known as a “pinched nerve” in the neck. The test is positive if pain, tingling, numbness, or weakness radiates from the neck into the shoulder, arm, or hand on the tilted side.
Symptom reproduction occurs because specific head and neck movements, combined with axial compression, temporarily increase pressure on an irritated or compressed cervical nerve root. The pain or other sensations follow the pathway of the affected nerve, indicating nerve root involvement. A positive test involves radiating symptoms down the arm, not just neck pain.
Common Causes and Symptoms
Cervical radiculopathy, often indicated by a positive Spurling’s test, arises when a nerve root in the neck is compressed or irritated. Common causes include a herniated disc, where soft disc material pushes through its outer layer and presses on nearby nerves. This can occur due to aging, repetitive neck motions, or sudden injury.
Another common cause involves degenerative changes in the spine, such as bone spurs (osteophytes) or narrowing of the spaces where nerves exit the spinal column. These age-related changes can gradually impinge upon nerve roots. Symptoms of cervical radiculopathy typically include pain radiating from the neck into the shoulder, arm, or hand. Patients may also experience numbness, tingling (“pins and needles”), or muscle weakness in the affected arm or hand, depending on the compromised nerve root.
Next Steps After a Positive Test
After a positive Spurling’s test, healthcare providers typically recommend further diagnostic evaluations to determine the precise cause and extent of nerve root compression. These steps often include a comprehensive physical examination and imaging tests. Magnetic Resonance Imaging (MRI) is frequently used for detailed soft tissue images, identifying herniated discs or nerve compression. X-rays show bone structures and degeneration, while CT scans offer detailed bony anatomy views.
Nerve conduction studies or electromyography (EMG) may be performed to assess nerve function and detect damage. Once cervical radiculopathy is diagnosed, treatment generally begins with conservative management. This includes physical therapy to strengthen neck muscles and improve range of motion, medication for pain and inflammation, and activity modification. If conservative measures do not provide sufficient relief, or if there are signs of neurological deficit, interventions like epidural steroid injections or surgical consultation may be considered.