Spurling Test: Purpose, Test Details & Results

Purpose of Spurling Test

The Spurling test is a cornerstone in the physical examination of patients experiencing neck and arm pain. Its main purpose is to help clinicians evaluate the presence of cervical radiculopathy—a condition where nerve roots in the cervical spine are compressed or irritated, often causing pain, numbness, or weakness down the arm. While it is a widely used maneuver in neurology and orthopedics, clinicians have varying opinions on its exact role, sensitivity, and how it should factor into diagnosis and treatment planning.

Understanding Cervical Radiculopathy

Cervical radiculopathy arises when one or more nerves in the neck are pinched, often due to herniated discs, degenerative changes, or other structural issues. This can lead to radiating pain, tingling, and sometimes muscle weakness, typically following a nerve distribution from the neck into the arm.

• Common symptoms: Neck pain radiating to the arm, numbness, tingling, or weakness.
• Causes: Disc herniation, osteophyte formation, degenerative disc disease.

Diagnosing cervical radiculopathy requires a blend of clinical history, physical examination, and sometimes imaging or electrodiagnostic testing. The Spurling test is one of several provocative maneuvers designed to reproduce the patient’s symptoms by mechanically compressing the affected nerve root.

The Role of the Spurling Test in Clinical Practice

The Spurling test is most valuable when used to confirm a suspected diagnosis rather than as a general screening tool. Its high specificity means a positive result strongly supports the presence of cervical radiculopathy, but a negative test does not rule it out, due to its lower sensitivity in certain populations 1. Clinicians integrate the Spurling test findings with other clinical data, such as imaging and nerve conduction studies, to reach a more definitive diagnosis 1, 2, 4.

Clinical Perspectives and Variability

Interestingly, there is some inconsistency among healthcare professionals regarding how the test should be performed and interpreted. Some see its value as moderate to low in the overall diagnostic process, particularly when used in isolation 4. Nevertheless, when combined with other findings, the Spurling test remains a key part of the examination for suspected cervical radiculopathy.

Spurling Test Details

The details of the Spurling test—how it is performed, its variations, and what constitutes a positive result—are crucial for clinicians to understand. Variations in technique and interpretation can impact the test's reliability and diagnostic utility.

How the Spurling Test Is Performed

The traditional Spurling test involves several steps:

1. Patient Position: The patient is seated comfortably, neck in a neutral position.
2. Head Movement: The examiner gently extends and laterally bends (side-bends) the neck toward the side of symptoms. Some variations include rotation as well 3, 4.
3. Axial Compression: Downward pressure is applied to the top of the patient’s head.
4. Symptom Observation: The test is considered positive if this maneuver reproduces the patient’s typical radiating arm pain or paresthesia (tingling), especially if it travels below the elbow 1, 3, 4.

Variations in Technique

Several modifications of the original Spurling maneuver have been described to improve diagnostic yield:

• Extension only: Neck is simply extended, then compressed.
• Extension + Lateral Bending: Most commonly used; increases nerve root compression.
• Extension + Lateral Bending + Rotation: Some clinicians add rotation toward the symptomatic side for greater provocation 3, 4.
• Staged Approach: Some experts recommend starting with extension and lateral bending, adding compression only if no symptoms are elicited 3.

A study comparing six different variations found that combining extension, lateral bending, and compression produced the most intense pain and most distally distributed symptoms, but was also less tolerable for some patients 3.

What Constitutes a Positive Spurling Test?

• Classic Positive: Reproduction of radiating pain or tingling into the arm, especially past the elbow, consistent with nerve root distribution 1, 3.
• Proximal Symptoms: Some clinicians consider neck or shoulder pain only as a positive, but this is controversial and less specific for radiculopathy 4.
• Distal Symptoms: Pain or paresthesia radiating into the forearm or hand is highly suggestive of nerve root involvement.

Interpreting the Results in Context

There is no universal agreement on the “best” way to perform the test; practice patterns vary between clinicians and even across specialties 4. Most agree, however, that the presence of distal symptoms (beyond the shoulder) is more diagnostically meaningful than isolated neck or shoulder discomfort.

Spurling Test Results & Follow-Up

Understanding the results of the Spurling test—and what to do next—is essential for optimal patient care. The test’s sensitivity, specificity, and predictive values have been studied extensively, but real-world practice still involves a degree of clinical judgment.

Sensitivity and Specificity: What Do the Numbers Mean?

• Sensitivity measures the test’s ability to correctly identify those with the disease.
• Specificity measures the ability to correctly identify those without the disease.

Reported values for the Spurling test vary widely:

• One large study found a sensitivity of 30% and specificity of 93% for diagnosing cervical radiculopathy using electromyography as the reference standard 1.
• Another study, looking specifically at soft lateral cervical disc prolapse, reported much higher sensitivity (92%) and specificity (95%) 2.

This variation highlights that test performance may depend on the patient population, the specific diagnosis (e.g., soft disc vs. hard disc/osteophyte), and the methodology used.

Positive Predictive Value and Clinical Usefulness

A high positive predictive value (the probability that someone with a positive test truly has the condition) means that a positive Spurling test result is strongly suggestive of cervical radiculopathy, especially when the clinical picture fits 2. However, a negative result cannot reliably exclude the diagnosis, since sensitivity may be low in some groups 1.

What Happens After the Test?

If the Test Is Positive

• A positive Spurling test, especially with classic distal symptoms, supports the diagnosis of cervical radiculopathy.
• Further testing—such as MRI or nerve conduction studies—is often performed to confirm the diagnosis and assess severity 1, 2.
• The findings guide treatment, which may include conservative management (physical therapy, medications) or, in some cases, surgical consultation 2.

If the Test Is Negative

• A negative test does not rule out cervical radiculopathy.
• The clinician must consider the overall clinical presentation, possibly ordering further tests if suspicion remains high 1, 2.

Clinical Decision-Making and Practice Variability

Despite its high specificity, the Spurling test is not universally relied upon as the sole determinant for diagnosis or treatment planning. Many clinicians regard the test as one piece of a larger diagnostic puzzle and value it most when interpreted in context with patient history, physical findings, and imaging results 4.

Variability in Test Use and Interpretation

• There is significant variability in how clinicians perform and interpret the Spurling test 4.
• Some consider neck or proximal shoulder pain sufficient for a positive test, while others require reproduction of classic, radiating arm symptoms.
• This inconsistency underscores the importance of standardized methodology and interpretation to improve diagnostic accuracy and patient care.

Conclusion

The Spurling test remains a valuable tool in the assessment of patients with suspected cervical radiculopathy. Its greatest strength lies in its high specificity—meaning that a positive test result is highly suggestive of true nerve root involvement. However, variability in test performance, interpretation, and sensitivity means that it should not be used in isolation. Instead, the Spurling test should be integrated as part of a comprehensive clinical assessment.

Key Points Covered:

• Purpose: The Spurling test is designed to help confirm, not screen for, cervical radiculopathy through mechanical provocation of nerve root symptoms 1, 2.
• Test Details: Technique involves neck extension, lateral bending, and compression; variations exist, and interpretation should focus on reproduction of classic radiating arm symptoms 3, 4.
• Results & Follow-Up: A positive test has high specificity and positive predictive value; negative test does not exclude diagnosis. Follow-up often involves imaging or electrodiagnostic studies, and practice patterns vary 1, 2, 4.
• Clinical Integration: The test is most valuable when used alongside other clinical findings and diagnostic tools.
• Practice Variability: Differences in methodology and interpretation highlight the need for standardized approaches to maximize test utility 4.

By understanding the strengths, limitations, and nuances of the Spurling test, clinicians can better diagnose and manage patients presenting with neck and arm pain—ultimately leading to more effective, patient-centered care.