Overview
This video discusses the Spurling's test for diagnosing cervical radicular syndrome, reviewing its diagnostic value and optimal application technique based on recent studies.
Diagnostic Value of Spurling's Test
- Spurling's test has a low sensitivity (50%) but good specificity (83%) for cervical radicular syndrome per Wainner et al. (2003).
- Multiple studies confirm that the test is more useful for confirming rather than ruling out diagnosis.
- Its clinical value is considered moderate due to these diagnostic characteristics.
Test Modifications and Research Findings
- Several modifications of the Spurling's test exist, as compared by Anekstein et al. (2011).
- The most provocative method involves neck extension, lateral bending to the affected side, and axial compression.
- This method produces the highest VAS pain scores and the most distal pain, aiding in differentiation between radiculopathy and spondylosis.
- Other versions mostly provoke proximal neck pain and are less diagnostically useful.
Recommended Test Procedure
- Begin the test with only neck extension and lateral bending to the affected side.
- Add axial compression only if symptoms are not elicited by the initial maneuvers.
- Gradually increase test intensity to maximize patient comfort, as the combination of extension, lateral bending, and compression is least tolerable.
Recommendations / Advice
- Use the extension, lateral bending, and compression variant for best diagnostic value, but apply components gradually for patient safety.
- Distal pain reproduction is key for diagnosing cervical radicular syndrome; otherwise, consider alternative diagnoses.