The Spurling’s test is a specialized physical examination maneuver used by healthcare professionals to determine the source of pain that begins in the neck and travels into the arm. Its function is to check for irritation or compression of the nerve roots as they exit the cervical spine (neck region). The test is a method of provocation, attempting to recreate the patient’s specific radiating symptoms to confirm a diagnosis. A positive result provides strong clinical evidence that a nerve in the neck is being pinched, guiding further testing or treatment.
How the Spurling’s Test is Performed
The maneuver is often referred to as a compression test because it involves applying a gentle downward force to the patient’s head. The patient is typically seated or standing while the examiner positions the neck. The head is first tilted and rotated toward the side of the patient’s arm pain. This combination of movements is designed to maximally narrow the intervertebral foramen, the opening where the nerve root exits the spinal canal. If this positioning reproduces the radiating arm pain, the test is considered positive. The practitioner may then apply light, downward pressure on the top of the head to further increase nerve root compression, confirming the result.
Understanding Cervical Radiculopathy
A positive Spurling’s test strongly suggests cervical radiculopathy, commonly known as a pinched nerve in the neck. This condition occurs when a nerve root is compressed or inflamed, causing neurological symptoms that radiate down the nerve’s path. Hallmark symptoms include pain, numbness, tingling, or weakness traveling from the neck and shoulder into the arm, hand, or fingers. The pain is often sharp or burning and exacerbated by neck movement.
The location of symptoms helps physicians pinpoint which nerve root is affected. For example, C7 compression may cause symptoms in the triceps muscle and middle finger, while C6 involvement affects the biceps muscle and the thumb. This pattern, known as a dermatomal distribution, is a distinguishing feature of radiculopathy. The test is only positive if symptoms radiate into the arm or hand, not just increased neck pain.
Common Causes of Nerve Root Compression
Nerve root compression identified by a positive Spurling’s test involves a narrowing of the spaces surrounding the nerve. The two most frequent causes are a herniated disc and degenerative changes associated with aging.
A herniated disc occurs when the soft, gel-like center of an intervertebral disc pushes through the outer layer. This extruded material directly presses on the spinal nerve root, causing inflammation and acute compression, and is more common in younger individuals.
Degenerative changes, known as cervical spondylosis, are prevalent in older adults and involve long-term wear of neck structures. As spinal discs lose height, the body may form extra bone, called osteophytes or bone spurs. These bony growths encroach upon the foramen, leading to chronic compression and irritation of the nerve root. This narrowing is known as foraminal stenosis.
Treatment Options Following a Positive Result
Following a positive Spurling’s test and confirmed cervical radiculopathy, the management pathway typically begins with non-surgical or conservative treatments. Most cases improve naturally over several weeks to months, making rest and activity modification the initial approach. Patients should temporarily limit strenuous activities, heavy lifting, and any positions that increase their pain. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen are often recommended to reduce inflammation around the irritated nerve root.
Physical therapy is a fundamental component of the recovery process, focusing on exercises to strengthen neck muscles, improve posture, and restore range of motion. A therapist may use techniques such as cervical traction to gently decompress the spine and create more space for the nerve.
If symptoms persist despite these initial measures, a physician may recommend a corticosteroid injection, such as an epidural steroid injection. This procedure delivers a strong anti-inflammatory medication directly into the space near the affected nerve root to provide targeted relief.
Surgery is generally reserved for individuals who experience severe or worsening neurological deficits, such as significant muscle weakness. It is also considered for those whose symptoms do not improve after six to twelve weeks of consistent non-surgical treatment. Surgical procedures aim to physically remove the source of the pressure, whether it is a herniated disc fragment or a bone spur, thereby decompressing the nerve root. The vast majority of people with cervical radiculopathy respond well to conservative care and recover without needing an operation.