Spurling's test: how to perform and interpret it

Spurling's test is a foraminal compression test for cervical radiculopathy. Side-bend the patient's neck toward the symptomatic side and apply gentle downward pressure through the top of the head. It is positive when it reproduces the patient's radiating arm pain. It is highly specific but not very sensitive, so a positive result supports radiculopathy while a negative result does not rule it out.

Purpose

To provoke nerve root symptoms by narrowing the intervertebral foramen on the symptomatic side.

How to perform the Spurling's test

  • Seat the patient upright with the neck in a neutral position.
  • Passively side-bend the neck toward the symptomatic side (some protocols add slight extension and rotation).
  • Apply gentle, gradual axial compression through the top of the head.
  • Stop as soon as symptoms are reproduced and ask where they are felt.

Positive result and interpretation

Reproduction of the patient's familiar radiating arm pain or paraesthesia in a dermatomal pattern.

Arm symptoms suggest nerve root involvement. Local neck pain only is not a positive result and may point to the facet joints instead.

Cluster it with

  • Cervical distraction test
  • Upper limb tension test A (median bias)
  • Cervical rotation less than 60° toward the symptomatic side

Common mistakes

  • Using excessive force - the test should be gentle and graded.
  • Counting local neck pain as a positive result.
  • Testing before screening for instability, fracture or vascular red flags after trauma.

Frequently asked questions

What does a positive Spurling's test mean?

Reproduction of radiating arm pain suggests cervical nerve root compression. Because the test is highly specific, a positive result meaningfully raises the probability of radiculopathy, especially alongside other items of Wainner's cluster.

When should you not perform Spurling's test?

Avoid it when instability, fracture, vertebrobasilar insufficiency or severe acute irritability is suspected, and after recent trauma until serious pathology has been ruled out.