Nov 01, 2010 the test is positive for cervical radiculopathy if axial loading to the top of the patients head reproduces the characteristic pain and radicular features. The numerous modifications of the spurling test described thus far simultaneously reiterate its important role in the diagnostic process of cervical radiculopathy and show the disagreement regarding the most appropriate way in which it should be performed. Shoulder abduction test sat, spurling test st, upper limb tension test ultt, and electromyography were done on 97 patients who referred to electrodiagnostic center in the university. Pdf what is the best way to apply the spurling test for. There are different ways described in the literature to perform the spurling s test. Value of physical tests in diagnosing cervical radiculopathy vrije. The value of provocative tests in diagnosis of cervical radiculopathy.
This will include observation of the patient as to how he holds his shoulders, neck and arms. Jan 03, 2015 spurling s test for cervical radiculopathy. If a patient shows signs of cervical radiculopathy, such as pinsandneedles tingling, weakness, or numbness in the shoulder, arm, andor hand, a doctor will likely conduct a patient history and exam, including a spurlings test. Learn vocabulary, terms, and more with flashcards, games, and other study tools. The aim of the study was to evaluate the accuracy of shoulder abduction test, spurling test, and upper limb tension test in the diagnosis of acute and chronic cervical radiculopathy on the basis of edx as the reference standard. Cervical spondylosis, and also in patients with tumor and multiple sclerosis ms this sign is negative in cervical radiculopathy. Jul 18, 2012 a diagnosis of cervical radiculopathy is based largely on clinical examination, including provocative testing. The correlation between spurling test and imaging studies in. Manual distraction may reduce the neck and limb symptoms in patients with cervical radiculopathy. Its essentially the sciatica of the upper extremity.
Value of physical tests in diagnosing cervical radiculopathy keele. Aug 16, 2017 the spurling s test is performed to assess cervical nerve root pain and impingement. The practitioner applies axial pressure through the top of the head. From 1988 to 1993, 255 consecutive patients were referred for electrodiagnosis of upper extremity nerve disorders. To determine the sensitivity and specificity of the spurling test for cervical radiculopathy. Since then, several modifications of the original maneuver have been proposed to improve its value in the diagnosis of cervical radiculopathy. The patient laterally flexes the head to the unaffected side first, followed by the affected side. The primary objective of this randomised clinical trial is to. The spurling test, shoulder abduction test, and upper limb tension test can be used to confirm the diagnosis. Reliability and validity of clinical tests to assess the. It is not a very sensitive test when used for individuals without classic radicular signs suggestive of cervical. Correlation between the physical examination using the spurling test to the imaging studies was done. Cervical radiculopathy weakness is the next most common finding. Diagnostic accuracy of the neck tornado test as a new screening.
Electrodiagnosis of cervical radiculopathy kevin hakimi, md, david spanier, md introduction cervical radiculopathy is a common disorder effecting people most often in the fourth and fifth decades of life. Two hundred fiftyseven patients with clinical cervical radiculopathy underwent complete physical examination that also included the spurling test. If edx findings consistent with cervical radiculopathy are found, the edx consultant should attempt to identify the specific nerve root affected and to assess the severity and chronicity of involvement. The spurling test, although a highly specific provocative test of the cervical spine in cervical radiculopathy cr, has low to moderate. We also searched the literature to identify studies on the reliability and validity of doppler. Cervical radiculopathy cr is a common condition occurring with an annual incidence rate of 63. Pdf what is the best way to apply the spurling test for cervical.
To determine the sensitivity and specificity of the. Cervical spine radiculopathy, spurlings test everything. The spurling test was scored as positive if it caused pain or tingling that started in the shoulder and radiated distally to the elbow. The most common nerve roots that are affected with cervical radiculopathy are nerves c5, c6, c7 and c8. Provocative diagnostic testing for cervical radiculopathy. Cervical radiculopathy is a disorder of the cervical spinal nerve root and most commonly is caused by degenerative changes, cervical disc herniation or other spaceoccupying lesion, resulting in nerve root inflammation, impingement, or both. Cervical radiculopathy is defined as cervical nerve root compression. Cervical radiculopathy and cervical myelopathy cervical spondylosis can progress to cause cervical radiculopathy or cervical myelopathy described below.
Cervical radiculopathy is a term used to describe pain ra diating into the arm corresponding to the dermatome of the. If you are a patient, seek care of a health care professional. Are tender points associated with cervical radiculopathy. Apply an axial compression force through the top of the head. Pdf the value of provocative tests in diagnosis of. Request pdf the spurling test and cervical radiculopathy a crosssectional study design was used. The correlation between spurling test and imaging studies. What is the best way to apply the spurling test for cervical.
Note that the test is not lateral flexion overpressure. This study was aimed at assessing the accuracy of provocative tests in diagnosis of acute or chronic cervical radiculopathy cr based on an electrodiagnostic reference criterion. The most common nerve root affected is c7, followed by c6. In this test, the clinician turns and tilts the patients head and neck toward the painful side and then adds a compressive force to the top of the head.
The spurling test had a sensitivity of 620 30% and a specificity of 160172 93%. Radiating pain or other neurological signs in the same side arm nerve root and or pain local to the neck or shoulder facet joint irritation. To assist in the diagnosis of cervical radiculopathy clinical prediction rule the following four criteria are considered predictive of the presence of cervical radiculopathy. The most common maneuver was described in 1944 by spurling and scoville. A number of studies strongly suggest that spurlings testbased on its specificity as a diagnostic measurecan definitively confirm the presence of cervical radiculopathy. What is the best way to apply the spurling test for.
Cervical nerve root compression resulting from disc degeneration and rootsleeve fibrosis. Jan 31, 2012 cervical radiculopathy is a common form of neck pain and has been shown to lead to severe disability. There are different ways described in the literature to perform the spurlings test. Provocative tests for cervical radiculopathy flashcards quizlet. One traditional test for cervical radiculopathy is the spurling test, or neck compression test. Radiculopathy forward thinking pt incorporating critical. Spurlings test cervical radicular syndrome youtube. Reproduction of pain may signal cervical radiculopathy, especially when combined with other tests. The correlation between spurling test and imaging studies in detecting cervical radiculopathy shay shabat md from the unit of spinal surgery, sapir medical center, israel and tel. Once aware of the symptoms a patient has that correspond to cervical radiculopathy, many doctors confirm this diagnosis by means of a manual test known as spurlings. To relieve the pressure on the cervical nerve roots. Cervical distraction after performing spurlings test purpose. Clinical rehabilitation approaches for cervical radiculopathies commonly include exercise and manual therapy interventions targeting the opening of intervertebral foramen, but evidence regarding their effectiveness is scarce.
Other advanced diagnostic tests, such as medical imaging, may also be ordered. Description the spurlings test is a provocative test for cervical radiculopathy. Spine volume 27, number 2, pp 156159 2002 davidson ri. The spinal cord travels down inside of the cervical spine in a bony cage. Spurlings test the spurlings test is performed if the patient complains of nerve root symptoms in the history which may be diminished or absent at the time of examination. Cervical radiculopathy is a primary disorder of the cervical nerve root, commonly manifesting as pain radiating from the neck to a dermatomal distribution of the affected nerve root. The neck or cervical spine is comprised of seven vertebral bones stacked in a column which support the head. The test is a combination of sidebending to the symptomatic side coupled with compression to reduce the diameter of the neural foramen and elicit the patients symptoms. Spurling s test is somewhat specific when used for individuals with an abnormal electromyogram study and is a relatively sensitive physical examination maneuver in diagnosing cervical spondylosis or acute cervical radiculopathy. Pdf a diagnosis of cervical radiculopathy is based largely on clinical examination, including provocative testing. There are many ways to perform the spurlings test for cervical radicular syndrome. Spurlings test aka foraminal compression test a positive test of pain radiating into the upper extremity towards the same side that the head is laterally flexed would indicate pressure on the nerve root. Many times, what causes this socalled compression is things like herniated disc material or arthritic bone spurs.
We assessed the ability of six known variations of the spurling test. Common symptoms include neck and radiating arm pain which can travel all the way down into the fingers. After that, all patients were sent to imaging studies of the cervical spine ct and or mri. The doctor will first conduct a physical examination of the person if he suspects that the pain is caused by cervical radiculopathy. Treatment of patients with degenerative cervical radiculopathy. Supported by the the university of michigan medical rehabilitation research training program grant t32 hd0742210. Nprs, upper limb tension testing, spurlings test, and the cervical distraction test were all completed on. However, it may be useful to be aware of the symptoms that suggest they may be happening, particularly as some of them may develop slowly. This is a pdf file of an unedited manuscript that has been accepted for.
A diagnosis of cervical radiculopathy is based largely on clinical examination, including provocative testing. Oct 08, 2018 the spurling test and cervical radiculopathy. Symptoms of pain, numbness, and or tingling may be mild, but in severe cases, cervical radiculopathy will be associated with motor weakness. The spurling s test also known as maximal cervical compression test and foraminal compression test is used during a musculoskeletal assessment of the cervical spine when looking for cervical nerve root compression causing cervical radiculopathy. In between each of the vertebrae is an intervertebral disc. The cervical radiculopathy occur due to the pressure over nerve root thus spurling test further provoke the symptoms while manual cervical distraction test decreased the symptoms of pain and numbness. Nonoperative management of cervical radiculopathy aafp. Positive spurling s test cervical spine radiculopathy duration. The value of provocative tests in diagnosis of cervical radiculopathy article pdf available in journal of research in medical sciences 18suppl 1.