Spurling's Test: Difference between revisions

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'''Original Editor '''- [[User:Shanae Gordon|Shanae Gordon]]
 
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== Purpose  ==
 
The Spurling's test (also known as Maximal Cervical Compression Test and Foraminal Compression Test) is used during a musculoskeletal assessment of the cervical spine when looking for cervical nerve root compression causing [[Cervical Radiculopathy]]<ref name="Konin et al">Konin JG, Wiksten DL, Isear JA, Brader H. Special Tests for Orthopedic Examination. Thorofare: SLACK Incorporated; 2006.</ref>.<br>
 
== Technique  ==
There are different ways described in the literature to perform the Spurling's test.  The version that provoked arm symptoms the best was with the neck in extension, lateral flexion and axial compression.<ref name="Anekstein et al">Anekstein Y, Blecher R, Smorgick Y, Mirovsky Y. What is the best way to apply the Spurling test for cervical radiculopathy? Clin.Orthop.Relat.Res. 2012;470(9):2566-2572.  </ref>
 
<clinicallyrelevant id="83459531" title="Spurlings test A" />
 
<clinicallyrelevant id="83459534" title="Spurlings test B" />
 
In some resources there is reference to test A and B, these variations are both used to assess for radiculopathy.<br>
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| {{#ev:youtube|3AIqxRrsCB4|300}}<ref>CRTechnologies. Spurlings A Test (CR).  Available from: http://www.youtube.com/watch?v=3AIqxRrsCB4 [last accessed 10/9/2019]</ref>
Original Editor - Your name will be added here if you created the original content for this page.  
| {{#ev:youtube|10MIrbqaYKo|300}}<ref>CRTechnologies. Spurlings B Test.  Available from: http://www.youtube.com/watch?v=10MIrbqaYKo [last accessed 10/9/2019] </ref>
|}
 
This video shows a good demonstration of Spurling's test plus other assessment techniques for cervical radiculopathy
 
{{#ev:youtube|YwR9EcKN_Jc|300}}<ref>Jmunoz85. Advanced Musculoskeletal Exam (pt. 1 of 7).  Available from: http://www.youtube.com/watch?v=YwR9EcKN_Jc [last accessed 10/9/2019] </ref>
== Evidence ==
When performing an [[Cervical Examination|assessment]] it is important to know if the tool you are using is measuring what you want to measure that is [http://ceaccp.oxfordjournals.org/content/8/6/221.full Specificity] and how good it is correctly identifying a pattern that is [http://ceaccp.oxfordjournals.org/content/8/6/221.full Sensitivity]<ref name="Lalkhen">Lalkhen A. McCluskey A. Clinical tests: sensitivity and specificity. Contin Educ Anaesth Crit Care Pain. 2008; 8 (6): 221-223.</ref>&nbsp;as both contribute to the diagnostic accuracy of the test.&nbsp;  
 
===== Diagnostic Accuracy<sup></sup><ref name="Flynn et al">Flynn TW, Cleland JA, Whitman JM. Users' Guide to the Musculoskeletal Examination. Buckner: Evidence in Motion; 2008.</ref>  =====


Lead Editors - Your name will be added here if you are a lead editor on this page.&nbsp; [[Physiopedia:Editors|Read more.]]
Sensitivity= .50


|}
Specificity= .88
 
-LR = .58
 
+LR= 3.5
 
===== Reliability<ref name="Flynn et al" /><sup></sup>  =====


<br>
Kappa= .60


== Purpose<br> ==
== Additional Information ==


add the purpose of this assessment technique here<br>
Although this test is commonly used for assessing cervical radiculopathy it is important due to its lower sensitivity that other tests are used in conjunction.&nbsp;In 2003, Dr. Robert Wainner and colleagues examined the accuracy of the clinical examination and developed a clinical prediction rule to aid in the diagnosis of cervical radiculopathy. Their research demonstrated that 4 clinical tests, when combined, hold high diagnostic accuracy compared to EMG studies:


== Technique<br>  ==
#'''Spurling's Test'''
#[[Neurodynamic Assessment#Upper_limb_tension_test_1_.28median_nerve_bias.29|Upper limb tension 1]]
#[[Cervical distraction test|Distraction test]]
#[[Cervical Flexion-Rotation Test|Cervical Rotation Test]]


Describe how to carry out this assessment technique here
When all 4 of these clinical features are present, the post-test probability of cervical radiculopathy is '''90%''', if only three of the four test are positive the probability decrease to '''65%''' <ref>Wainner RS, Fritz JM, Irrgang JJ, Boninger ML, Delitto A, Allison S. Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy. Spine 2003; 28(1):52-62</ref><ref name="Sid">Rubinstein SM, Pool JJ, van Tulder MW, Riphagen II, de Vet HC. [http://www.ncbi.nlm.nih.gov/pubmed/17013656 A systematic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy.] Eur Spine J. 2007; 16: 307-319.</ref>.


== Evidence ==
== Additional Resources ==


Provide the evidence for this technique here
De Hertogh WJ, Vaes PH, Vijverman V, De Cordt A, Duquet W. [http://www.ncbi.nlm.nih.gov/pubmed/16769236 The clinical examination of neck pain patients: The validity of a group of tests.] Manual Therapy. 2007; 12 (1): 50-5.


== Resources  ==
Tong HC, Haig AJ, Yamakawa K. [http://www.ncbi.nlm.nih.gov/pubmed/11805661 The Spurling test and cervical radiculopathy.] Spine. 2002:27(2):156-9.


add any relevant resources here
Rubinstein SM, Pool JJ, van Tulder MW, Riphagen II, de Vet HC. [http://www.ncbi.nlm.nih.gov/pubmed/17013656 A systematic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy.] Eur Spine J. 2007; 16: 307-319.


== References<br> ==
Shah KC, Rajshekhar V. [http://www.ncbi.nlm.nih.gov/pubmed/15799149 Reliability of diagnosis of soft cervical disc prolapse using Spurling's test.] British Journal of Neurosurgery. 2004: 18(5): 480-483.
== References  ==


<references />  
<references /><br>  


{{Template:Disclaimer}}
[[Category:Assessment]]
[[Category:Cervical Spine - Assessment and Examination]]
[[Category:Cervical Spine]]
[[Category:Special_Tests]]
[[Category:Neurological - Assessment and Examination]]
[[Category:Musculoskeletal/Orthopaedics]]
[[Category:MCG_Student_Project]]
[[Category:Cervical Spine - Assessment and Examination]]
[[Category:Cervical Spine - Special Tests]]

Latest revision as of 00:00, 1 February 2021

Original Editor - Shanae Gordon

Top Contributors - Admin, Shanae Gordon, Scott Buxton, Rachael Lowe, Uchechukwu Chukwuemeka, Kim Jackson, WikiSysop, Evan Thomas, Naomi O'Reilly, Tarina van der Stockt, Kai A. Sigel, Tony Lowe, Eric Robertson and Dan Rhon

Purpose[edit | edit source]

The Spurling's test (also known as Maximal Cervical Compression Test and Foraminal Compression Test) is used during a musculoskeletal assessment of the cervical spine when looking for cervical nerve root compression causing Cervical Radiculopathy[1].

Technique[edit | edit source]

There are different ways described in the literature to perform the Spurling's test. The version that provoked arm symptoms the best was with the neck in extension, lateral flexion and axial compression.[2]

Spurlings test A video provided by Clinically Relevant

Spurlings test B video provided by Clinically Relevant

In some resources there is reference to test A and B, these variations are both used to assess for radiculopathy.

[3]
[4]

This video shows a good demonstration of Spurling's test plus other assessment techniques for cervical radiculopathy

[5]

Evidence[edit | edit source]

When performing an assessment it is important to know if the tool you are using is measuring what you want to measure that is Specificity and how good it is correctly identifying a pattern that is Sensitivity[6] as both contribute to the diagnostic accuracy of the test. 

Diagnostic Accuracy[7][edit | edit source]

Sensitivity= .50

Specificity= .88

-LR = .58

+LR= 3.5

Reliability[7][edit | edit source]

Kappa= .60

Additional Information[edit | edit source]

Although this test is commonly used for assessing cervical radiculopathy it is important due to its lower sensitivity that other tests are used in conjunction. In 2003, Dr. Robert Wainner and colleagues examined the accuracy of the clinical examination and developed a clinical prediction rule to aid in the diagnosis of cervical radiculopathy. Their research demonstrated that 4 clinical tests, when combined, hold high diagnostic accuracy compared to EMG studies:

  1. Spurling's Test
  2. Upper limb tension 1
  3. Distraction test
  4. Cervical Rotation Test

When all 4 of these clinical features are present, the post-test probability of cervical radiculopathy is 90%, if only three of the four test are positive the probability decrease to 65% [8][9].

Additional Resources[edit | edit source]

De Hertogh WJ, Vaes PH, Vijverman V, De Cordt A, Duquet W. The clinical examination of neck pain patients: The validity of a group of tests. Manual Therapy. 2007; 12 (1): 50-5.

Tong HC, Haig AJ, Yamakawa K. The Spurling test and cervical radiculopathy. Spine. 2002:27(2):156-9.

Rubinstein SM, Pool JJ, van Tulder MW, Riphagen II, de Vet HC. A systematic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy. Eur Spine J. 2007; 16: 307-319.

Shah KC, Rajshekhar V. Reliability of diagnosis of soft cervical disc prolapse using Spurling's test. British Journal of Neurosurgery. 2004: 18(5): 480-483.

References[edit | edit source]

  1. ↑ Konin JG, Wiksten DL, Isear JA, Brader H. Special Tests for Orthopedic Examination. Thorofare: SLACK Incorporated; 2006.
  2. ↑ Anekstein Y, Blecher R, Smorgick Y, Mirovsky Y. What is the best way to apply the Spurling test for cervical radiculopathy? Clin.Orthop.Relat.Res. 2012;470(9):2566-2572.
  3. ↑ CRTechnologies. Spurlings A Test (CR). Available from: http://www.youtube.com/watch?v=3AIqxRrsCB4 [last accessed 10/9/2019]
  4. ↑ CRTechnologies. Spurlings B Test. Available from: http://www.youtube.com/watch?v=10MIrbqaYKo [last accessed 10/9/2019]
  5. ↑ Jmunoz85. Advanced Musculoskeletal Exam (pt. 1 of 7). Available from: http://www.youtube.com/watch?v=YwR9EcKN_Jc [last accessed 10/9/2019]
  6. ↑ Lalkhen A. McCluskey A. Clinical tests: sensitivity and specificity. Contin Educ Anaesth Crit Care Pain. 2008; 8 (6): 221-223.
  7. ↑ 7.0 7.1 Flynn TW, Cleland JA, Whitman JM. Users' Guide to the Musculoskeletal Examination. Buckner: Evidence in Motion; 2008.
  8. ↑ Wainner RS, Fritz JM, Irrgang JJ, Boninger ML, Delitto A, Allison S. Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy. Spine 2003; 28(1):52-62
  9. ↑ Rubinstein SM, Pool JJ, van Tulder MW, Riphagen II, de Vet HC. A systematic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy. Eur Spine J. 2007; 16: 307-319.


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