Spurling’s Test

What is the Spurling's Test?

The Spurling test, initially named Spurling's neck compression test by neurosurgeons Roy Glen Spurling and William Beecher Scoville, was introduced in 1944 to evaluate "radiculitis." It is also known as the foraminal compression test, Spurling's neck compression test, or the quadrant test.

Spurling's Test is mainly used to detect nerve root compression in the cervical spine (Shelow et al., 2020). Numerous disorders, including ruptured discs, bone spurs, and degenerative disc degeneration, might contribute to this compression. Head and neck pain, arm pain, numbness, tingling, and paralysis can result from cervical spine compression.

The original procedure for Spurling's Test was developed in 1944 and is no longer considered the proper technique (Jones & Miller, 2020). According to a study by Anekstein et al. (2012), the procedure that can provoke the most symptoms related to unilateral cervical radiculopathy involves the following steps:

1. With the patient in a seated position, extend the neck.
2. Position the patient's head at lateral flexion towards the affected side.
3. Apply downward pressure.

This test has a low sensitivity at 0.50, but it has a high specificity at 0.88 (Wainner et al., 2003).

How does this printable Spurling's Test work?

Our Printable Spurling's Test template provides healthcare professionals with a structured approach to performing and documenting the test. It includes the step-by-step procedure, space to record results, and a visual guide for the proper positioning.

Step 1: Access the template

Start by accessing the Spurling’s Test template via the "Use template" button in the Carepatron app or download the PDF version by clicking "Download."

Step 2: Explain the test

Before conducting the test, explain to the patient that it is used to check for nerve compression in the neck. Clarify the purpose of the test and make sure the patient is comfortable.

Step 3: Perform the test

Follow the steps outlined in the template to perform the Spurling's Test. Ensure that you follow the correct procedure for neck extension, lateral flexion, and applying compression.

Step 4: Record results and discuss them

Document the results on the provided template. Afterward, discuss the findings with the patient and explain the next steps, whether the test results are positive or negative.

Results and interpretation

If the patient feels pain, numbness, tingling, or weakness during the test and it is replicated during the maneuver, the nerve root is crushed. This is a positive Spurling Test and may point to a cervical spine issue.

It is important to remember that a positive test alone cannot confirm cervical spine disease; the results must be assessed alongside the patient's medical history, physical examination, and imaging tests.

When to use this assessment?

Spurling's assessment is a screening tool healthcare providers use to identify nerve root compression in the cervical spine. The test is typically used in patients with symptoms of cervical radiculopathies, such as neck pain, shoulder pain, arm pain, or weakness.

Here are some situations where Spurling's assessment may be appropriate:

• Suspected cervical radiculopathy: When a patient exhibits cervical radiculopathy symptoms such as neck discomfort, shoulder pain, arm pain, or weakness, Spurling's examination is frequently performed. If a medical professional suspects the patient has this illness, the test may be used to confirm the diagnosis.
• History of cervical spine injury: If the patient has a history of cervical spine damage, such as a herniated disc or spinal stenosis, the healthcare professional may use Spurling's Test to determine the severity of nerve root compression and the best course of action.
• Unexplained neck or arm pain: If the patient complains of unexplained neck or arm pain, the healthcare professional may utilize Spurling's Test to rule out or confirm cervical spine problems as the underlying cause.
• Post-surgical evaluation: The medical professional may use Spurling's Test to evaluate the patient's nerve root function following cervical spine surgery and identify any remaining nerve root compression necessitating additional care.
• Follow-up evaluation: Healthcare professionals may use Spurling's Test during follow-up exams on patients who have already been diagnosed with cervical spine disorders to track the disease's development and modify the treatment strategy as necessary.

It is essential to note that a positive Spurling's Test alone is not enough to diagnose a cervical spine condition. Further imaging studies, such as X-rays, MRI, or CT scans, may be necessary to confirm cervical radiculopathy and assess neck pain causes that Spurling's Test does not cover.

Benefits of a free Spurling's Test template

Spurling's Test is one of the most common provocative tests professionals use. A template you can access and fill out quickly will make your practice more efficient. Here are the benefits of using Spurling's Test template:

• Standardization: The template offers standardized exam methods, guaranteeing uniform testing and accurate diagnoses among healthcare practitioners.
• Organization: The template organizes the test results documentation, making it simple for other healthcare professionals engaged in the patient's care to review and communicate the data.
• Time-saving: The template can save healthcare providers time by offering a pre-formatted document that can be swiftly filled out during patient evaluations.
• Increased efficiency: The template can make healthcare providers' jobs easier by eliminating the need for manual documentation and data entry.

Regularly update your patient's data to provide them with the best treatment options and care plans.

Next steps

While Spurling’s Test is a useful tool for detecting cervical radiculopathy, further evaluation and treatment are often necessary to address the underlying condition. Below are the next steps following a positive result:

1. Imaging studies

If the test is positive, follow up with imaging studies such as X-rays, MRI, or CT scans to further assess the extent of nerve root compression and guide treatment planning.

2. Referral to a specialist

Refer the patient to an orthopedic specialist or neurologist for a comprehensive evaluation and management plan, particularly if the symptoms are severe or worsening.

3. Physical therapy

For many patients, physical therapy is a key component of managing cervical radiculopathy. A physical therapist can design an exercise program to improve strength and flexibility in the neck.

4. Surgical consultation

In cases where conservative treatments fail, or the nerve compression is severe, a surgical consultation may be necessary to discuss options such as discectomy or foraminotomy.

References

Jones, S. J., & Miller, J.-M. M. (2020). Spurling Test. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK493152/

Shelow, J., Krug, T., Homol III, T., Nigro, V., O'Neal, C., & Holbein-Jenny, M. A. (2020, June 7). Spurling Test, Maximal Cervical Compression Test, Foraminal Compression Test, Neck Compression Test, Quadrant Test. American Physical Therapy Association. https://www.apta.org/patient-care/evidence-based-practice-resources/test-measures/spurling-test#

Wainner, R. S., Fritz, J. M., Irrgang, J. J., Boninger, M. L., Delitto, A., & Allison, S. (2003). Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy. Spine, 28(1), 52–62. https://doi.org/10.1097/00007632-200301010-00014