Spurling’s Test

The Spurling’s Test is performed if the patient complains of nerve root symptoms in the history which may be diminished or absent at the time of examination.

Execution (traditional): The patient laterally flexes the head to the unaffected side first, followed by the affected side. The examiner carefully presses straight down on the head.

Outcome: Reproduction of symptoms or pain radiating down the arm on the same side as the head is bent during compression, which indicates pressure on the nerve root.

A modified version of the Spurling’s Test suggests to perform this test in three stages; of which each stage is increasingly provocative. Once symptoms are produced the examiner does not proceed to the next stage.

Execution (modified): The first stage involves compress with the head in neutral. The second stage involves compression with the head in extension. The final stage has the head placed in extension and rotation, first to the unaffected side, then to the side of complaint; followed by compression.

Outcome: Reproduction of symptoms at any stage, or pain radiating down the arm towards which the head is rotated during compression.

Note: Neck pain with no radiation into the shoulder or arm is not considered a positive test. Cervical radiculopathy implies pain in the dermatomal distribution of the affected nerve root. The distribution of pain and altered sensation may give an indication of the involved nerve root (Magee 2007).

Sensitivity ranges from 30%-95%
Specificity ranges from 74%-100%
(Chhanalal et al. 2004, Ghasemi et al. 2013, Shabat et al. 2011, Shah et al. 2004, Tong et al. 2002, Viikari-Juntura et al. 1989, Wainner et al. 2003)

See THESIS, section “Spurling’s Test” for further discussion.