The Spurling’s Test is a physical examination maneuver used by clinicians to evaluate neck pain. It is a provocative test designed to intentionally reproduce the patient’s symptoms to isolate the source of discomfort. Its primary purpose is to assess for irritation or compression of the nerve roots in the upper spine, a condition known as cervical radiculopathy. This rapid, non-invasive method helps guide the diagnostic process before complex imaging studies.
Understanding Cervical Radiculopathy
Cervical radiculopathy occurs when a spinal nerve root in the neck becomes pinched, irritated, or inflamed as it exits the spinal column. The cervical spine is composed of seven stacked vertebrae, separated by intervertebral discs that act as shock absorbers. Nerve roots branch out from the spinal cord through small openings, known as the neural foramina, traveling down the shoulders, arms, and hands.
Compression of these nerve roots can be caused by structural changes, such as a herniated disc or degenerative changes like the formation of bone spurs (osteophytes). When the nerve is compressed, it disrupts signal transmission, leading to characteristic radicular symptoms. These symptoms typically manifest as pain, numbness, tingling, or muscle weakness that radiates from the neck down into the arm and hand, often following a specific nerve pathway.
The location and type of symptoms experienced correspond directly to the affected nerve root. Pain from a compressed nerve root is frequently described as sharp, burning, or shooting, and may be accompanied by a pins-and-needles sensation. The Spurling’s Test is formulated to physically narrow the space around the nerve root, temporarily increasing pressure to determine if this reproduces the patient’s radiating discomfort.
Performing the Spurling’s Test
The Spurling’s Test is typically performed with the patient seated upright on an examination table. The clinician stands behind the patient to guide the head and neck through a precise series of movements. The goal of the procedure is to systematically decrease the available space within the neural foramen on the side where the patient is experiencing arm symptoms.
The maneuver begins by gently guiding the patient’s head into extension, which involves tilting the chin upward. Next, the head is rotated and laterally flexed toward the side of the patient’s reported symptoms. This combination of movements is intended to align the vertebrae to minimize the size of the neural foramen.
Once the head is positioned, the final step involves the clinician applying a gentle, downward compression force to the top of the patient’s head. This load mechanically increases the pressure on the nerve root. The clinician closely monitors the patient for any reproduction of radiating arm pain during this sustained compression, immediately ceasing the pressure if symptoms are provoked.
Interpreting the Test Results
The outcome of the Spurling’s Test is determined by the patient’s response. A positive result is recorded only when the test reproduces or significantly worsens the patient’s existing radicular symptoms, specifically the radiating pain, numbness, or tingling that travels down the arm. A positive test is not indicated by mere localized neck pain, as this discomfort could be due to muscle or joint strain.
The reproduction of symptoms confirms that mechanical compression of a cervical nerve root likely underlies the patient’s radiating pain complaint. Conversely, a negative result occurs if the patient reports only localized neck pain or no change in symptoms at all during the compression. A negative test suggests that radiculopathy may be absent or that the nerve irritation is not mechanically reproducible.
The test is considered a tool for confirmation, not a standalone diagnostic measure. The interpretation of a positive result points toward a high probability of nerve root compression occurring on the ipsilateral side (the side to which the head was tilted). Clinicians use this immediate, physical evidence to help correlate the patient’s symptoms with a likely structural cause.
Role of the Test in the Diagnostic Process
The Spurling’s Test holds a valuable position within the overall assessment of neck pain and arm symptoms. It is noted for having high specificity, meaning that a positive result indicates a high likelihood of cervical radiculopathy. A positive result provides strong clinical evidence supporting the presence of nerve root compression.
The test’s sensitivity, however, can be variable and is generally considered lower than its specificity, meaning a negative result does not completely exclude the possibility of cervical radiculopathy. Because of this characteristic, clinicians rarely rely on the Spurling’s Test in isolation to confirm a diagnosis. Instead, it is used as one component within a cluster of physical examination findings, alongside a detailed patient history and a full neurological assessment.
A positive Spurling’s Test combined with evidence of arm weakness or diminished reflexes provides a stronger clinical picture. Even with a positive result, imaging studies, such as Magnetic Resonance Imaging (MRI), are often required to precisely identify the underlying cause of the compression, such as a specific disc herniation or bone spur. The test’s utility is primarily in rapidly guiding the clinician toward the most likely diagnosis and determining the necessity and focus of subsequent imaging or treatment plans.