Spurling test (or as it called Spurling compression test) is a provocative test designed to exacerbate encroachment of a cervical nerve root at the neural foramen by extension and rotation of the neck toward the involved side.
It was first described in 1944 by Roy Glenwood Spurling (1894 – 1968) and William Beecher Scoville (1906 – 1984) who were American neurosurgeons.
See Also: Shoulder Abduction Test (Bakody Test)
The Spurling test is considered positive if pain radiates into the limb ipsilateral to the side at which the head is rotated.
The Spurling test sensitivity is low, but it has high specificity 1 for cervical radiculopathy diagnosed by electromyography. Therefore, it is not useful as a screening test, but it is clinically useful in helping to confirm a cervical radiculopathy.
In another study the spurling test has a high Sensitivity (92 – 95 %) and high Specificity (94 – 95 %).
Modifications to Spurling Test have been advocated, which divide the test into three stages, each of which is more provocative. If symptoms are reproduced, the clinician does not progress to the next stage.
No diagnostic accuracy studies have been performed to determine the sensitivity and specificity of these variations.
Cervical Spine Distraction Test is the opposite of spurling test. It helps to determine whether pain in the back of the neck, shoulder, and arm is radicular in origin or is due to ligamentous or muscular causes
While the patient is seated. The examiner grasps the patient’s head about the jaw and the back of the head and applies superior axial traction.
Distraction of the cervical spine reduces the load on the intervertebral disks and exiting nerve roots within the affected levels or segments while producing a gliding motion in the facet joints. Reduction of radicular symptoms, even in passive rotation, when the cervical spine is distracted is a sign of discogenic nerve root irritation. Increased pain during distraction and rotation suggests a functional impairment in the cervical spine due to muscular or ligamentous pathology or articular, possibly degenerative processes.
The Cervical Spine Distraction Test has a Sensitivity of 44 % and a Specificity of 97 %.
Pain on the concave side indicates nerve root irritation or facet joint pathology (Spurling sign), while pain on the convex side indicates muscle strain (reverse Spurling sign).
The patient may feel no discomfort, a sensation of heaviness, nonradicular or pseudoradicular pain, or radicular pain:
Pain related to muscular strains or mild ligamentous sprains is not normally aggravated by these tests.
The test is an aggressive cervical compression test, and the patient should be prepared for each step of the examination.
The Spurling test should not be performed when cervical fracture, dislocation, or instability are suspected.
Anatomically, Cervical nerve roots exit above their corresponding vertebrae (e.g., C5 nerve roots exits at C4-C5 neural foramen). Consequently, disc herniation at C5-C6 involves the C6 nerve root. Recognize that disc herniation at C7-T1 involves the C8 nerve root.
Cervical radiculopathy is a disorder of the cervical nerve root, presenting as pain that radiates from the neck to a dermatomal segment distribution of the affected cervical nerve root. It can be due to a herniated disc, discoosteophytic complex, facet arthropathy, thickened ligamentum flavum, uncovertebral osteophyte, and other conditions.
Numerous clinical examination findings are purported to be diagnostic of cervical radiculopathy including patient history, cervical range of motion limitations, neurologic examination, and specific maneuvers (e.g., Spurling test). Most of these items have demonstrated a fair or better level of reliability.
However, because the clinical presentation of cervical radiculopathy is so variable, it is advisable to use a combination of test results before making a diagnosis.
It is important to obtain a detailed history to establish a diagnosis of a cervical radiculopathy and to rule out other causes. The clinician should first determine the main complaint (i.e., head or neck pain, numbness, weakness, decreased neck function) and location of symptoms. Anatomic pain drawings can be helpful by supplying the clinician with a quick review of the pain pattern.
Magnetic Resonance Imaging (MRI) is the best choice for cervical pathology diagnosis. Computed Tomography (CT) scans can also be used and are less expensive, but should be used with caution as they can expose patients to unnecessary radiation.
|Disk Level||Nerve Root||Motor Deficit||Sensory Deficit||Reflex Compromise|
|Anterolateral shoulder and arm||Biceps Muscle|
|Lateral forearm and hand|
|Brachoradialis Muscle |
Pronator teres Muscle
|C6-C7||C7||Wrist flexors Muscle |
Finger extensors Muscle
|Middle finger||Triceps Muscle|
|C7-T1||C8||Finger flexors Muscle|
Hand intrinsic Muscles
|Medial forearm and hand and ring and little fingers||None|
|T1-T2||T1||Hand intrinsic Muscles||Medial forearm||None|
In middle-aged and older patients, the symptoms are often the result of degenerative changes and compression of the
neural structures by osteophytes rather than disk herniation. Prior episodes of similar symptoms or localized neck pain are important for the diagnosis and ultimate intervention.
The older patient may have had previous episodes of neck pain or give a history of having arthritis of the cervical spine.
Leg symptoms associated with neck dysfunction, especially in the elderly, should arouse the suspicion of cervical spondylotic myelopathy.
Conservative intervention consists of modified rest, a cervical collar, oral corticosteroid, and NSAIDs.
Surgical intervention is reserved for patients with persistent radicular pain who do not respond to conservative measures.