The Spurling Test, also known as Spurling’s Maneuver or the Foraminal Compression Test, is a physical examination technique used by clinicians to identify the source of a patient’s neck and arm pain. This diagnostic tool is a provocative test, meaning it is designed to reproduce a patient’s existing symptoms. By applying specific movements and pressure to the neck, the test temporarily narrows the space around the spinal nerves. This helps determine if nerve root irritation is causing discomfort radiating into the upper extremity, guiding further diagnostic imaging and treatment decisions.
The Procedure: How the Spurling Test is Performed
The Spurling Test is typically performed with the patient seated and the clinician standing behind them to control head and neck movements. The procedure is incremental, progressing through stages of increasing provocation to minimize discomfort. The first stage involves gently tilting the patient’s head to the side of the reported symptoms, known as lateral flexion.
If this movement does not reproduce the patient’s arm symptoms, the second stage combines lateral flexion with slight extension of the neck. The final and most provocative stage adds rotation of the head toward the symptomatic side, which maximally narrows the openings where the nerve roots exit the cervical spine. At any stage, the clinician may apply a light, downward axial compression force to the top of the head to amplify the movement’s effect. The test is immediately stopped if the patient reports a reproduction of their radiating arm pain, numbness, or tingling.
Understanding the Results: Positive, Negative, and Cautionary Findings
The interpretation of the Spurling Test focuses entirely on the patient’s subjective experience during the maneuver. A result is considered “positive” only if the specific symptoms the patient originally reported—such as pain, numbness, or tingling—are reproduced and radiate down the arm. This reproduction of radiating symptoms indicates that the movement has temporarily compressed or irritated a nerve root in the cervical spine, suggesting a potential nerve root issue.
If the patient experiences only localized neck pain or discomfort without symptoms radiating into the shoulder or arm, the test is considered “negative” for nerve root compression. Localized pain may suggest other sources of pain, such as muscle strain or facet joint irritation. The severity of the symptoms and the specific area of the arm affected help the clinician pinpoint which level of the cervical spine is compromised.
The Target Condition: Cervical Radiculopathy
The primary condition the Spurling Test screens for is Cervical Radiculopathy. This condition is characterized by neurological dysfunction resulting from the compression or inflammation of a spinal nerve root in the neck. Symptoms are related to the specific nerve root affected, often presenting as pain, weakness, or altered sensation that follows a predictable path into the upper extremity, known as a dermatomal pattern.
The mechanical pressure on the nerve root is most commonly caused by degenerative changes within the cervical spine. In younger individuals, a herniated intervertebral disc can press directly on a nerve root. As people age, the condition is more frequently linked to cervical spondylosis, which involves the formation of bony outgrowths called osteophytes or bone spurs.
These degenerative changes cause a narrowing of the intervertebral foramen, the small opening through which the nerve root exits the spinal canal. This narrowing, or foraminal stenosis, reduces the space available for the nerve, leading to mechanical irritation and inflammation. The typical presentation is a sharp or electric pain that originates in the neck and travels down the arm, sometimes accompanied by a pins-and-needles sensation or muscle weakness.
Accuracy and Contraindications
The clinical usefulness of the Spurling Test is defined by its high specificity. A positive result is a strong indicator that the patient likely has Cervical Radiculopathy, with specificity values often reported around 93% or higher. However, the test has lower sensitivity, meaning a negative result does not completely rule out a nerve root problem.
The sensitivity of the test is variable in scientific literature, sometimes reported as low as 30%. Because the test can temporarily increase nerve root compression, it should not be performed in certain circumstances. Contraindications include:
- Suspicion of severe spinal instability.
- Signs of spinal cord compression (myelopathy).
- Severe, intolerable pain that prevents the required movements.
- Infectious processes or malignancy.
- Recent acute trauma to the cervical spine.