Spurling's Test

Original Editor - Shanae Gordon

Top Contributors - Shanae Gordon, Scott Buxton, Rachael Lowe, Evan Thomas and Naomi O'Reilly

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[1].

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.[2]

[3]

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



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

Evidence

When performing an assessment it is important to know if the tool you are using is measuring what you want to measure Specificity and how good it is correctly identifying a pattern Sensitivity[4] both contribute to the diagnostic accuracy of the test. 

Diagnostic Accuracy[5]

Sensitivity= .50

Specificity= .88

-LR = .58

+LR= 3.5

Reliability[5]

Kappa= .60

Additional Information

Although this test is commonly used for assessing cervical radiculopathy it is important due to its lower sensitivity that other tests are used in conjuction. 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 probablity of cervical radiculopathy is 90%, if only three of the four test are positive the probability decrease to 65% [6][7].

Additional Resources

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 Feb; 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.

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

  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. Physiotutors. Spurling's Test | Cervical Radicular Syndrome. Available from: https://www.youtube.com/watch?v=3ZSNdv0o0yk
  4. Lalkhen A. McCluskey A. Clinical tests: sensitivity and specificity. Contin Educ Anaesth Crit Care Pain (2008) 8 (6): 221-223.
  5. 5.0 5.1 Flynn TW, Cleland JA, Whitman JM. Users' Guide to the Musculoskeletal Examination. Buckner: Evidence in Motion; 2008.
  6. Wainner et al. Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy. Spine 2003 Jan 1. 28(1):52-62
  7. Sidney M. Rubinstein et al. A systematic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy. European Spine Journal. Volume 16, Number 3, 307-319