The Spurling Test is a physical examination maneuver used by healthcare providers to help diagnose the source of arm pain and other symptoms originating from the neck. It is considered a provocative test, meaning the clinician intentionally performs an action designed to reproduce the patient’s typical symptoms. The procedure narrows the space where nerve roots exit the spine, temporarily increasing pressure on an irritated nerve. Understanding the test involves knowing the condition it screens for, the steps of the maneuver, and how to interpret the results.
The Condition the Test Screens For
The Spurling Test screens for cervical radiculopathy, commonly referred to as a pinched nerve in the neck. This condition occurs when a nerve root in the cervical spine becomes compressed or irritated. These nerve roots branch out from the spinal cord through small openings between the vertebrae, called foramina, and travel down the arms to the hands.
When a nerve root is compressed, symptoms are felt along the path of that specific nerve, not just in the neck. The most recognizable symptom is pain that radiates from the neck and shoulder down the arm, often described as sharp or burning. A person may also experience numbness, tingling, or altered sensation in the arm or hand. Muscle weakness or a loss of reflexes can also occur, depending on the compression’s severity and location.
Cervical radiculopathy is typically caused by structural changes that narrow the nerve’s exit path. In younger adults, a common cause is a herniated disc pressing on the adjacent nerve root. In older adults, the condition is more frequently caused by degenerative changes like bone spurs (osteophytes) or thickening of the ligaments, leading to foraminal stenosis (narrowing of the nerve opening).
The Steps of the Spurling Test
The Spurling Test, sometimes called the Neck Compression Test, is performed while the patient is seated upright. The healthcare provider stands behind the patient and gently guides the head into a specific series of movements designed to progressively reduce the space around the nerve roots.
The first movement involves slight neck extension and tilting the head toward the reported symptoms (lateral flexion). This action begins to narrow the neural foramen, which may reproduce the radiating arm pain. If this initial movement does not produce symptoms, the clinician adds rotation. The patient’s head is rotated toward the painful side while maintaining the lateral flexion and extension, further reducing the space available for the nerve root.
The final step involves applying gentle downward pressure, or axial compression, onto the top of the patient’s head. This downward force amplifies the compression of the nerve root within the narrowed foramen. The sequence is performed slowly and stopped immediately if the patient reports the onset of their radiating arm symptoms.
Understanding Positive and Negative Results
The interpretation of the Spurling Test relies entirely on the reproduction of the patient’s symptoms. A test is considered “positive” if the maneuver recreates the patient’s specific radicular symptoms, such as radiating pain, tingling, or numbness that travels down the arm. The reproduction of these symptoms strongly suggests the presence of a compressed or irritated nerve root in the cervical spine. The test is not positive if the patient only experiences localized neck pain, as this can be due to other causes like muscle strain.
A “negative” result occurs if the patient reports no change in symptoms, or only feels non-radiating, localized discomfort in the neck. This outcome does not necessarily rule out cervical radiculopathy, but it indicates the nerve root was not sufficiently compressed to reproduce the arm symptoms. A positive test guides the provider toward the diagnosis of nerve root compression and often prompts further diagnostic imaging, such as an MRI.
Safety and Accuracy Considerations
While the Spurling Test is a common diagnostic tool, certain safety constraints must be observed. It should not be performed on patients with suspected cervical spine instability, such as those with recent severe trauma or conditions like rheumatoid arthritis that weaken the neck’s structure. The test should also be avoided if the patient has a known infection or malignancy affecting the cervical spine, as compression and movement could be dangerous.
The Spurling Test is known for its high specificity but lower sensitivity. High specificity means a positive result strongly confirms the presence of cervical radiculopathy. Conversely, low sensitivity means a negative result does not definitively rule out the condition, as a pinched nerve may still be present. Therefore, the test is used as one piece of evidence in a comprehensive physical and neurological examination, alongside other tests and the patient’s history.