Execution
- 1Have the patient sit upright with symptoms currently mild or absent enough to tolerate provocation.
- 2First apply gentle axial compression with the head neutral.
- 3If no symptoms are reproduced, examiner repeats compression with cervical extension.
- 4If still negative, examiner positions the neck into extension with rotation or side flexion toward the symptomatic side and applies careful axial compression.
- 5Stop once familiar arm symptoms are reproduced.
Positive outcome
Radiating pain or paresthesia into the ipsilateral arm is positive and suggests cervical nerve root irritation or compression. Neck pain alone without arm radiation is not a true positive for cervical radiculopathy.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Tong et al. (2002) | NA | 30 | 93 | 4.29 | 0.75 |
| Sandmark & Nisell (1995) | NA | 77 | 92 | 9.62 | 0.25 |
| Shabat et al. (2012) | NA | 95 | 94 | 15.83 | 0.05 |
CommentSpurling's test is more useful for ruling in cervical radiculopathy than for screening because sensitivity varies substantially across studies. The test is provocative, so it should be used cautiously in highly irritable presentations. Cohort-context note: the high Shabat 2012 values (Sn 95 / Sp 94) come from 257 patients pre-selected for clinical cervical radiculopathy and verified against CT/MRI imaging, while Tong 2002's lower Sn 30% used electrodiagnosis as reference in a more general electrodiagnostic-clinic population. Both citations have been verified against PubMed; the difference reflects pre-test probability, not contradictory evidence.
High Clinical Value