What is the Best Way to Apply the Spurling Test for Cervical Radiculopathy?

Abstract

Background A diagnosis of cervical radiculopathy is based largely on clinical examination, including provocative testing. The most common maneuver was described in 1944 by Spurling and Scoville. Since then, several modifications of the original maneuver have been proposed to improve its value in the diagnosis of cervical radiculopathy. Questions/Purposes We assessed the ability of six known variations of the Spurling test to reproduce the complaints of patients diagnosed with cervical radiculopathy. Methods We prospectively enrolled 67 patients presenting with cervical radicular-like symptoms and concordant radiographic findings. Each patient underwent six distinct provocative cervical spine maneuvers by two examiners, during which three parameters were recorded: (1) pain intensity (VAS score), (2) paresthesia intensity (0 -no paresthesia, 1 -mild to moderate, and 2 -severe), and (3) characteristic pain distribution (0 -no pain, 1 -neck pain only, 2 -arm pain only, 3 -pain elicited distal to the elbow). The interobserver reliability of the reported VAS score (measured by the intraclass coefficient correlation) ranged from 0.78 to 0.96 and the calculated kappa values of the categorical parameters ranged from 0.58 to 1.0 for paresthesia intensity and from 0.63 to 1.0 for pain distribution. Differences in scores elicited between the two examiners for the 67 patients were resolved by consensus. Results A maneuver consisting of extension, lateral bending, and axial compression resulted in the highest VAS score (mean, 7) and was associated with the most distally elicited pain on average (mean, 2.5). The highest paresthesia levels were reported after applying extension, rotation, and axial compression (mean, 1). These maneuvers, however, were the least tolerable, causing discontinuation of the examination on three occasions. Conclusions Whenever cervical radiculopathy is suspected our observations suggest the staged provocative maneuvers that should be included in the physical evaluation are extension and lateral bending first, followed by the addition of axial compression in cases with an inconclusive effect. Level of Evidence Level II, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

The Virtual Spine Examination: Telemedicine in the Era of COVID-19 and Beyond

“…This maneuver, even without axial compression, is a reliable provocative test in the diagnosis of cervical radiculopathy. 24 The shoulder abduction test for cervical radiculopathy is well-suited for telemedicine. 25 Patients are instructed to abduct their shoulder and hold their arm above their head.…”

Neurovascular Disorders

“…Combining the results of these three studies, it appears that lateral rotation of the neck decreases the sensitivity of the test for the detection of cervical radiculopathy. This rationale is supported by Anekstein et al [ 11 ] who found the greatest sensitivity with the combination of lateral bending and extension without rotation. Thus, we prefer to perform the Spurling's test in neutral rotation to improve diagnostic effi cacy.…”

Clinical characteristics of patients with posterosuperior labral tear: a comparison with patients with other shoulder disorders

“… 15 , 16 A Spurling test was also performed to rule out the presence of cervical radiculopathy. 17 , 18 …”