The Spurling Test is a physical examination technique utilized by healthcare professionals to assess the presence of specific nerve issues affecting the neck and arm. Introduced in 1944 by neurosurgeons Roy Glen Spurling and William Beecher Scoville, it is also known by names such as the Maximal Cervical Compression Test or Foraminal Compression Test. This test serves as a “provocative” maneuver, meaning it aims to reproduce a patient’s symptoms to help pinpoint their origin. It is a non-invasive assessment performed as part of a broader clinical evaluation.
Purpose of the Test
The primary goal of the Spurling Test is to identify whether symptoms of arm and neck pain stem from cervical radiculopathy. Cervical radiculopathy occurs when a nerve root in the neck becomes irritated or compressed as it exits the spinal cord. This compression can arise from various factors, including a herniated disc, degenerative changes in the spine, bone spurs, or swelling.
When a nerve root is compressed, it can lead to a range of symptoms that radiate from the neck into the shoulder, arm, and even the hand. These symptoms typically include pain, numbness, or tingling sensations, and sometimes muscle weakness in the affected limb. The Spurling Test helps clinicians determine if these radiating symptoms are indeed linked to nerve root compression in the cervical spine.
How the Test is Performed
The Spurling Test is conducted with the patient seated, ensuring they are comfortable and relaxed. The healthcare provider begins by gently tilting and extending the patient’s head to the side where they are experiencing symptoms. This initial movement aims to narrow the spaces where nerve roots exit the spinal column, known as the neuroforamina.
Following this, the provider may also gently rotate the head towards the symptomatic side. To further challenge the nerve roots, a light, downward axial compression is then applied to the top of the patient’s head. This combination of movements and pressure is designed to increase the compression on potentially irritated nerve roots, attempting to reproduce the patient’s characteristic radiating pain or other sensations. The test is stopped if symptoms are reproduced, ensuring patient comfort and safety.
Interpreting the Results
The results of a Spurling Test are typically categorized as either positive or negative. A positive Spurling Test occurs when the specific radiating symptoms, such as pain, numbness, or tingling, are reproduced or worsened down the arm, shoulder, or hand during the maneuver. This reproduction of symptoms suggests that a nerve root in the cervical spine is likely being compressed or irritated.
Conversely, a negative Spurling Test means that the patient does not experience the radiating arm symptoms during the test. If pain is localized only to the neck, or if no symptoms are reproduced, the test is considered negative for cervical radiculopathy. A negative result indicates that nerve root compression may not be the cause of the patient’s neck and arm pain, prompting the healthcare provider to investigate other potential sources.
Key Considerations
The Spurling Test is a useful component of a comprehensive clinical evaluation for neck and arm pain, but it is not typically used in isolation for diagnosis. It is generally performed by trained healthcare professionals, including orthopedic specialists, neurologists, and physical therapists. The test’s diagnostic value is considered to be highly specific, meaning that if it is positive, it strongly indicates cervical radiculopathy. However, its sensitivity is often described as mild-to-moderate, which means a negative result does not completely rule out the condition.
Certain situations warrant caution or avoidance of the Spurling Test. It should not be performed if there is a suspicion of cervical spine instability, such as in cases of acute trauma, certain infections, malignancy, or conditions like cervical spondylotic myelopathy or rheumatoid arthritis. These conditions could be exacerbated by the movements and compression involved in the test. Therefore, the Spurling Test serves as one piece of information, complementing a thorough medical history, other physical examinations, and sometimes imaging studies like MRI or CT scans, to arrive at an accurate diagnosis.