The Spurling’s test is a common physical examination technique utilized by clinicians to evaluate the source of neck pain radiating into the arm. This quick, non-invasive maneuver is designed to provoke symptoms associated with an irritated or compressed nerve root in the neck. Understanding the result provides an important initial step in diagnosing the underlying problem. A positive finding helps direct subsequent diagnostic steps and the treatment plan.
Understanding the Spurling’s Maneuver
The Spurling’s maneuver, sometimes called the maximal cervical compression test, is performed while the patient is seated. The goal is to strategically narrow the intervertebral foramina—the openings in the cervical spine where the nerve roots exit. A clinician guides the patient’s head into extension and lateral bending toward the side of the reported pain.
This movement is followed by the gentle application of an axial compression force, or downward pressure, to the top of the patient’s head. This combination of movements decreases the space around the nerve root, temporarily increasing any existing irritation. The test is immediately stopped if symptoms are reproduced, prioritizing patient comfort and safety.
A positive result is defined by the reproduction of the patient’s radicular symptoms, which are sensations that travel down the arm. These symptoms include shooting pain, numbness, or a tingling sensation. If the patient only experiences localized neck pain during the maneuver, the test is considered negative for nerve root compression.
Clinical Significance of a Positive Finding
A positive Spurling’s test result strongly suggests cervical radiculopathy. This diagnosis involves the irritation or compression of one or more nerve roots branching from the spinal cord in the neck. The test is considered highly specific, meaning a positive result indicates a high probability that cervical radiculopathy is the cause of the arm symptoms.
Cervical radiculopathy causes characteristic symptoms that follow the distribution of the affected nerve root into the upper extremity. Patients report pain originating in the neck that radiates into the shoulder, arm, or hand, often traveling past the elbow. Compression can also disrupt the nerve’s ability to transmit signals, leading to sensory changes like tingling or numbness in the fingers or hand.
The condition may also present with motor deficits, causing weakness in the specific muscles supplied by the irritated nerve root. While the Spurling’s test is a valuable tool for focusing the diagnosis, it is not used in isolation. A definitive diagnosis requires correlation with the patient’s full medical history and a comprehensive neurological examination.
Common Causes of Cervical Nerve Root Compression
The mechanism behind a positive Spurling’s test is the physical narrowing of the space where the nerve root exits the spinal canal, caused by two primary anatomical issues. The first is a cervical disc herniation, often seen in younger patients or following an acute injury. This occurs when the soft material within an intervertebral disc bulges or ruptures, pressing directly onto the adjacent nerve root.
The second common cause involves age-related changes, categorized as cervical spondylosis or foraminal stenosis. As people age, discs lose height, and the body may grow small bone spurs, known as osteophytes, to stabilize the spine. These bony growths project into the intervertebral foramen, gradually narrowing the opening and compressing the nerve root.
In both disc herniation and spondylosis, the Spurling’s maneuver increases compression on the irritated nerve root. Rotating and extending the neck toward the painful side naturally reduces the diameter of the foramen, reproducing the radicular pain. The specific pattern of symptoms experienced in the arm and hand is determined by the level of the cervical spine affected.
Initial Steps Following Diagnosis
Following a positive Spurling’s test and a diagnosis of cervical radiculopathy, the initial approach focuses on conservative, non-surgical management. The primary goals are to reduce inflammation, alleviate pain, and restore function. Activity modification is recommended, involving the avoidance of movements, like looking up or turning the head quickly, that aggravate the symptoms.
Physical therapy is a standard component of initial care, utilizing techniques such as gentle manual therapy, specific strengthening exercises, and cervical traction to decompress the nerve root. Non-steroidal anti-inflammatory drugs (NSAIDs) may be prescribed for a short duration to decrease inflammation around the compressed nerve. For severe pain, a clinician may consider an oral course of corticosteroids or an epidural steroid injection for rapid symptom relief.
If symptoms do not significantly improve after four to six weeks of conservative treatment, or if there are signs of progressive neurological deficit, further diagnostic tools are employed. Magnetic Resonance Imaging (MRI) is the preferred imaging modality, providing detailed visualization of soft tissues to confirm the exact location and cause of compression. Most cases of cervical radiculopathy improve substantially with conservative care, and surgery is reserved for intractable pain or severe neurological compromise.