Execution
- 1Perform ULNT1 and mark it positive if familiar symptoms are reproduced and altered by sensitising movements.
- 2Measure active cervical rotation toward the symptomatic side and mark it positive if rotation is less than 60°.
- 3Perform Spurling's test and mark it positive if familiar ipsilateral arm symptoms are reproduced.
- 4Perform cervical distraction and mark it positive if familiar radicular symptoms are reduced.
- 5Interpret the cluster by counting positive findings; three of four increases suspicion and four of four strongly increases the likelihood of cervical radiculopathy.
Positive outcome
The cluster is positive when at least three of the four component findings are present. Four positive findings produces the strongest rule-in value.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Wainner et al. (2003) — 3/4 positive | NA | 39 | 94 | 6.10 | 0.65 |
| Wainner et al. (2003) — 4/4 positive | NA | 24 | 99 | 30.30 | 0.77 |
CommentThis is one of the highest-value clinical tools for suspected cervical radiculopathy because it combines provocation, relief, ROM loss, and neurodynamic sensitivity. The original confidence intervals were wide, so it should support rather than replace clinical reasoning. Methodological note: the 4/4 LR+ of 30.3 widely cited from Wainner reflects confidence-interval handling in the original paper; the raw point estimate from Sn 24 / Sp 99 is closer to 24. Both are above the LR+ ≥ 10 threshold for "strong rule-in", but students should be aware the precise number depends on how Sp = 99% in a small sample is treated.
High Clinical Value