Spurling Test : Types, Purpose, Techniques, Results and More

Overview

Doctors use the Spurling test to evaluate the likely causes of cervical radiculopathy. Cervical radiculopathy happens when a nerve in the neck is pinched near the region where it branches away from the spinal cord. There are several causes, including a herniated disc or degenerative changes that occur naturally as we age. 

Common symptoms of cervical radiculopathy include weakness, pain, or numbness in the arm or hand muscles. A person may also feel pain across the neck, upper back, or shoulders.

A positive result may indicate a pinched nerve. 

This blog is a comprehensive understanding of the Spurling test, its purpose, techniques, and the meaning of the results.

What is the Spurling test?

The Spurling test helps doctors diagnose cervical radiculopathy and rule out other causes of pain. Cervical radiculopathy occurs if a nerve in the neck is compressed or irritated where it branches away from the spinal cord. Many factors can cause it, including a herniated disc or degenerative changes that generally occur as people age. The common symptoms include pain, weakness, or numbness in the arm or hand muscles. People may also experience pain across their upper back, shoulders, or neck.

How is the Spurling test performed?

Doctors perform the Spurling test when people sit in a chair or on an examination table. There are many variations of the test. However, the most common ones are the Spurling test A and Spurling test B. 

• Spurling test A : In this test, the patient is asked to bend their head towards the side of the body where symptoms appear. They also apply some pressure to the top of the patient’s head.
• Spurling test B : In addition to bending the patient’s head toward their symptomatic side, the doctor may extend and rotate the neck while applying pressure to the top of the patient’s head.

When should you call the doctor?

When you believe you have cervical radiculopathy, you speak to the doctor about performing the Spurling test.

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What does a positive result indicate?

A positive Spurling test result means the patient feels pain radiating into their arm during the test. The doctor stops the test as soon as the patient feels the pain. Based on the symptoms, the doctor may perform some additional tests to confirm their diagnosis.

What does a normal result indicate?

A normal Spurling test result means the patient does not feel any pain during the test. However, a normal result does not always mean that the patient does not have cervical radiculopathy.

Following a normal test result, the doctor may likely perform additional tests to evaluate the patient for other signs of cervical radiculopathy or another condition that may cause the symptoms. Some of the additional tests include the following: 

• Shoulder abduction test – in this test, the palm of the affected arm is placed over the top of the head. If the patient’s symptoms go away when they do this, it is considered a positive result.
• Upper limb tension test – various upper limb tension tests are designed to place stress on the nerves running from the patient’s neck down their arm. During these tests, each nerve gets stretched or stressed to evaluate if the patient displays symptoms.
• Imaging tests – the doctor can use X-rays, CT scans, or MRI scans to better look at the affected area and rule out any other causes of the pain, including an injury.
• Nerve conduction studies – these tests evaluate how quickly a nerve impulse moves through the patient’s nerve, which may help the doctor identify nerve damage.

What are the next steps that the doctors take after performing the Spurling test? 

After performing a Spurling test, the doctors can suggest additional tests to make a diagnosis. When the tests confirm a pinched nerve, the treatment options may include: 

1. The temporary use of a soft cervical collar restricts neck motion and supports inflamed neck muscles.
2. Physical therapy to strengthen the neck muscles and improve the range of motion
3. Over-the-counter (OTC) nonsteroidal anti-inflammatory drugs such as ibuprofen
4. Prescription steroid medications to minimize the swelling and inflammation in the area
5. A cervical pillow to support the healthy curvature of the neck
6. Surgery for severe cases
7. Gentle traction with the assistance of a physical therapist or lightweight training.

Approximately 88 per cent of people with pinched nerve pain recover within four weeks of starting the nonsurgical treatment.

Conclusion

Doctors use the Spurling test to diagnose cervical radiculopathy. When the patient feels pain during the test, it is considered a positive result, which means they may have cervical radiculopathy. A normal result means the patient may not feel any pain and suggests that they do not have cervical radiculopathy. The patients must remember that this test is not entirely accurate. Therefore, the doctor may likely perform some additional testing.

Frequently Asked Questions (FAQs)

1. What are the other names for the Spurling test? 

The Spurling test is also known as the Spurling compression test or Spurling manoeuvre.

2. What is the accuracy of the Spurling test?

Medical tests are assessed for their sensitivity and specificity to: 

• Identifying patients who do not have the associated condition accurately.
• Identifying patients with the associated disorder.

While the Spurling test is not always entirely accurate, it is an easy way for doctors to start ruling out the likely causes of the patient’s symptoms. The result can also guide doctors toward other diagnostic tests to help them better identify the condition. 

What other tests may the doctor use to diagnose the cause of the pain?

In addition to the Spurling test, the other provocative tests doctors may use during the spinal examination to discover the cause of the pain include the shoulder abduction (relief) sign, neck distraction test, L’Hermitte’s sign, Hoffman’s sign, and Adson’s test.