Spurling’s test

Purpose: To identify the presence of cervical radiculopathy among patients with upper quadrant pain.

Patient Position: Sitting upright.

Examiner Position: Standing beside or behind the patient.

Procedure: Move the patient’s head into lateral flexion/rotation to the unaffected side. Carefully apply axial compression vertically downwards through the head. Repeat the same on the affected side.

Bradley et al. suggestions:
Stage 1: Compress the head in neutral position.
Stage 2: Compress the head in extension.
Stage 3: Position the head in extension and rotate to the unaffected side and then apply compression. Repeat the same on the affected side.

Outcome: The test is positive if the patient has radiating pain down the arm on the corresponding dermatome ipsilaterally. The findings should be used to confirm cervical radiculopathy/nerve compression in conjunction with other neurologic/manual tests.

Reverse Spurling sign is positive if pain or radiating symptoms are present on the contralateral side to which the head is bent or rotated during Spurling’s test, indicating muscle spasm or soft tissue tightness causing neural symptoms.

Other Names: Spurling’s Maneuver, Foramen Compression test, Maximal Cervical Compression Test.

References:
1. Magee DJ. Orthopedic Physical Assessment. 5th ed. St. Louis, MO: Saunders Elsevier; 2008. http://amzn.to/2kUVoPs
2. Tong, H. C., Haig, A. J., & Yamakawa, K. (2002). The Spurling test and cervical radiculopathy. Spine, 27(2), 156-159.
3.  Bradley JP, Tibone RE, Watkins RG. History, physical examination, and diagnostic tests for neck and upper extremity problems. In: Watkins RG, editor. The Spine in Sports. St Louis, MO: Mosby-Year Book Inc; 1996. pp. 71–81.
4. Anekstein, Yoram, et al. “What is the best way to apply the Spurling test for cervical radiculopathy?.” Clinical Orthopaedics and Related Research® 470.9 (2012): 2566-2572.

Text Book References:
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