Spurling’s test is a physical examination maneuver used to check for cervical radiculopathy, a condition where a nerve in the neck is compressed or irritated. During the test, a healthcare provider positions your head and applies downward pressure to see if it reproduces pain, tingling, or numbness radiating into your arm. It’s one of the most commonly used bedside tests for pinched nerves in the neck and takes less than a minute to perform.
How the Test Works
The basic idea behind Spurling’s test is simple: it temporarily narrows the openings where nerves exit the spine. Your cervical vertebrae have small passageways called foramina on each side, and spinal nerves pass through them on their way to your shoulders, arms, and hands. When the head is tilted and compressed, these openings shrink slightly. If a nerve is already being crowded by a herniated disc, bone spur, or other structural problem, this added narrowing can provoke symptoms.
The test is considered positive when the maneuver reproduces your characteristic pain and radicular features, meaning symptoms that travel down your arm in the pattern of the affected nerve. Pain that stays in the neck alone, without radiating into the shoulder or arm, is not considered a positive result.
What Happens During the Test
You’ll be seated while your provider stands behind or beside you. The most common version used today involves three movements: your head is passively extended (tilted back), rotated toward the painful side, and then the provider applies a gentle downward compressive force to the top of your head. The combination of extension, rotation, and compression closes down the nerve opening on the side being tested.
There is no single standardized protocol. The American Physical Therapy Association notes that six variations exist in the medical literature, ranging from lateral bending with compression alone to extension combined with rotation and compression. The original version described by Spurling himself used only lateral bending (tilting the head sideways) with axial compression. Your provider may use whichever variation they find most reliable, and they’ll typically test both sides for comparison.
The force applied is moderate. Your provider isn’t trying to cause injury. They’re looking for whether even light to moderate compression is enough to trigger recognizable symptoms. The test is stopped immediately if it reproduces your pain.
Who Should Not Have This Test
Because the maneuver involves compressing the cervical spine, it’s not appropriate for everyone. According to Cleveland Clinic, providers will typically skip this test or choose alternatives if you have cervical spine instability, a recent spine injury, cervical spondylotic myelopathy (spinal cord compression in the neck), rheumatoid arthritis affecting the cervical spine, or metastatic cancer that may have spread to the vertebrae. Each of these conditions creates a risk that compression could cause further damage.
Accuracy: High Specificity, Variable Sensitivity
Spurling’s test is better at confirming a pinched nerve than at ruling one out. A systematic review of the available evidence found that specificity ranges from 89% to 100%, meaning a positive result is very reliable. When the test reproduces your arm symptoms, there’s a strong chance you actually have cervical radiculopathy. False positives are rare.
Sensitivity is a different story, ranging from 38% to 97% across studies. This wide range means a negative result doesn’t necessarily clear you. Some people with genuine nerve compression won’t have symptoms provoked by the maneuver, possibly because their nerve irritation is positional or intermittent, or because the specific variation used didn’t compress the right foramen enough.
In practical terms: if the test is positive, your provider can be fairly confident about the diagnosis. If it’s negative, they’ll likely move on to other tests rather than dismissing the possibility.
How It Fits With Other Tests
Spurling’s test is rarely used in isolation. It’s one component of a well-studied four-test cluster developed by researchers to diagnose cervical radiculopathy without imaging. The four tests are Spurling’s test, the upper limb tension test (which stretches the nerve through the arm), the cervical distraction test (which gently pulls the head upward to open the foramina), and a check for whether neck rotation toward the affected side is limited to less than 60 degrees.
When three of these four tests are positive, the likelihood of cervical radiculopathy jumps significantly, with a positive likelihood ratio of 6.1. When all four are positive, that number climbs to 30.3, making the diagnosis near-certain even before an MRI. With only two positive, the cluster doesn’t meaningfully change the probability one way or the other.
The distraction test works as a useful counterpart to Spurling’s. Where Spurling’s compresses the nerve openings to provoke symptoms, distraction opens them to relieve symptoms. If pulling gently upward on your head reduces your arm pain, that’s further evidence the problem is nerve compression in the neck.
What a Positive Result Means for You
A positive Spurling’s test points toward cervical radiculopathy, but it’s a clinical finding, not a final diagnosis. Your provider will consider it alongside your symptoms, history, and other examination findings. If the clinical picture is clear, treatment may begin with conservative approaches like physical therapy and activity modification. If the diagnosis is uncertain or symptoms are severe, imaging such as an MRI will typically follow to identify exactly which nerve is affected and what’s compressing it.
The test itself carries minimal risk when performed on appropriate candidates. You may feel a brief reproduction of your usual symptoms during the maneuver, but it should not cause lasting pain or new neurological problems. If the maneuver doesn’t provoke any arm symptoms, your provider will note a negative result and continue evaluating other possible causes of your neck or arm pain.