The Spurling test is a physical examination technique healthcare providers use to help diagnose a specific type of nerve irritation in the neck. The test aims to recreate your discomfort, providing valuable clues for diagnosis of a compressed nerve in the cervical spine.
Pinched Nerve in the Neck
A pinched nerve in the neck is medically known as cervical radiculopathy. This condition occurs when a nerve root in the cervical spine becomes compressed or irritated. These nerve roots branch from the spinal cord through small openings in the vertebrae, carrying signals to and from the arms and hands. When compressed, symptoms often include pain, numbness, tingling, or weakness that can radiate from the neck down into the shoulder, arm, or hand. Common causes range from age-related degenerative changes like arthritis and bone spurs to acute issues such as a herniated disc.
Performing the Test
During the Spurling test, the patient sits upright on an examination table. The healthcare provider positions the patient’s head, tilting it towards the symptomatic side and extending it slightly backward. This positioning narrows the small openings in the vertebrae where nerve roots exit the spinal column. Gentle downward pressure is then applied to the top of the patient’s head, further reducing space around the nerve root and potentially reproducing or intensifying arm symptoms. The provider observes the patient’s response closely, stopping the test immediately if significant pain or discomfort occurs.
Understanding Your Results
The Spurling test outcome is categorized as either positive or negative. A positive result occurs when the maneuver reproduces or worsens the patient’s radiating symptoms, such as pain, tingling, or numbness, down the arm. This suggests the presence of nerve root compression in the cervical spine. Conversely, a negative result means that the test did not reproduce or worsen arm symptoms. If pain is felt only in the neck and does not radiate down the arm, the test is not considered positive for cervical radiculopathy. While a positive Spurling test is a strong indicator, it is generally not considered definitive on its own.
Importance and Considerations
The Spurling test is a valuable tool within a broader diagnostic evaluation. Healthcare providers use it with a patient’s medical history, other physical examination findings, and sometimes imaging studies for a comprehensive diagnosis. While the test has high specificity, meaning it is good at confirming cervical radiculopathy when positive, its sensitivity can be low to moderate. This means a negative result does not always definitively rule out a pinched nerve, so a comprehensive assessment involving multiple tests and clinical judgment is essential for an accurate diagnosis. The Spurling test is generally avoided in situations like suspected cervical spine instability, recent acute trauma, or malignancy, to ensure patient safety.