Spurling Test

Excerpt

Neck pain affects approximately 10% of the adult population at any given time. This means that primary care providers and other specialists will frequently see patients with this complaint in the office. In modern medicine, these cases are often immediately sent for imaging. Although Magnetic Resonance Imaging (MRI) is considered the test of choice for cervical pathology, it is contraindicated in some patients with implants and can also be cost prohibitive. Computed Tomography (CT) scans can also be used and are less expensive, but should be used with caution as they can expose patients to unnecessary doses of radiation. Even in the era of high-quality imaging studies, a history and physical examination remain the cornerstone of the profession, and should never be discounted.

A variety of unique physical exam tests can be utilized to help determine the source of pathology and the need for additional imaging. These include provocative tests that are frequently utilized in the evaluation of cervical radiculopathy. The Spurling test is one of the best-known and most widely used provocative tests for the assessment of the cervical spine.

The Spurling test was originally named as Spurling’s neck compression test by the neurosurgeons Roy Glen Spurling and William Beecher Scoville. It was proposed in 1944 for use in the evaluation of “radiculitis.” The test has also been referred to as the Foraminal Compression Test, Neck Compression Test, or Quadrant Test. The Spurling test is considered a provocative test used in the spinal examination. In several previous trials (mostly conducted in the late 1900’s), the test had proven to have high specificity, but low sensitivity. A more recent study showed more promising accuracy with a sensitivity of 95% with a specificity of 94%. This trial, however, only included patients who were presenting with symptoms of unilateral cervical radiculopathy lasting for at least four weeks. This resulted in the indirect exclusion of many of the alternative diagnoses that the Spurling test is used to help differentiate, and eliminated many other confounding variables. In short, while studies show conflicting data, the current consensus remains that the Spurling test is highly specific with only mild-to-moderate overall sensitivity.

Because of its relatively low sensitivity, the Spurling test should not be used as the only screening tool. It is best used combined with other specialized examination tests (some of which are mentioned below) to increase overall screening sensitivity, and should always be accompanied by thorough patient history.