The Spurling’s test is a standard physical examination technique used by healthcare professionals to evaluate patients experiencing neck and arm pain. This maneuver is a provocative test, designed to temporarily recreate a patient’s specific symptoms to help identify the source of the discomfort. Physicians, physical therapists, and chiropractors often incorporate this technique into a comprehensive orthopedic assessment. It helps determine if the patient’s radiating pain is due to a mechanical problem in the neck.
Screening for Cervical Radiculopathy
The primary function of the Spurling’s test is to screen for cervical radiculopathy. This condition describes the irritation or compression of a nerve root as it exits the cervical spine (neck). A nerve root can become “pinched” due to a herniated disc or from degenerative changes like bone spurs that narrow the spinal openings. Patients typically present with pain, numbness, weakness, or a tingling sensation (paresthesia), which radiates from the neck and shoulder down into the arm, forearm, or hand. Identifying this source guides the subsequent treatment plan, differentiating nerve compression from other causes of shoulder or arm pain.
Performing the Spurling’s Maneuver
The Spurling’s maneuver is performed with the patient seated comfortably, allowing the examiner to control the position of the head and neck. The test is initiated by gently guiding the patient’s head into lateral flexion (side-bending) toward the side of their reported symptoms. Next, the examiner adds slight extension and rotation of the neck toward the same symptomatic side. This combined movement is designed to reduce the size of the neural foramen, the small openings between the vertebrae through which the spinal nerve roots pass. Finally, the examiner applies gentle, downward pressure (axial compression) to the top of the patient’s head, which temporarily narrows the space around the nerve root and mechanically increases pressure on a potentially compromised nerve.
Interpreting Positive and Negative Outcomes
A positive result occurs when the maneuver successfully reproduces the patient’s radicular symptoms, such as sharp pain or tingling that radiates down the arm. Because this provocation test directly stresses the nerve root, the reproduction of arm symptoms suggests the presence of cervical radiculopathy. The test is considered to have high specificity, meaning a positive result strongly indicates that the nerve root is the source of the problem. A negative result, where the patient feels no reproduction of arm symptoms, does not necessarily exclude cervical radiculopathy; it suggests the nerve compression is not severe enough to be provoked by this mechanical stress, as the test has variable sensitivity. A positive test often warrants further confirmation through diagnostic imaging, such as Magnetic Resonance Imaging (MRI) scan, to visualize the cause of the nerve root compression.