Spurling’s Test

What is a Spurling's Test?

The Spurling test, initially named Spurling's neck compression test by neurosurgeons Roy Glen Spurling and William Beecher Scoville, was introduced in 1944 to evaluate "radiculitis." It is also known as the Foraminal Compression Test, Neck Compression Test, Maximal Cervical Compression Test, or Quadrant Test. Medical experts use Spurling's Test in diagnosing cervical radiculopathy (Jones & Miller, 2020; Shelow et al., 2020).

Spurling's Test is mainly used to detect nerve root compression in the cervical spine. Numerous disorders, including ruptured discs, bone spurs, and degenerative disc degeneration, might contribute to this compression. Neck pain, arm pain, numbness, tingling, and paralysis can result from cervical spine compression.

The test begins with the basic cervical compression test. Inform the patient of the procedure and ask them to report any pain or sensations. With the patient's head in a neutral position, apply pressure and stop if pain or numbness radiates down the arm, indicating nerve root compression. If there's no pain, proceed to Spurling's Compression Test by extending the neck and applying downward pressure, then rotating the head while extended and applying compression, and finally, combining extension, rotation, and lateral flexion before pressing down again (The University of West Alabama Athletic Training & Sports Medicine Center, n.d.).

How does this printable Spurling's Test work?

The printable Spurling's Test is a tool healthcare providers use to document the results of the physical examination maneuver. It is a straightforward and easy-to-use template that can be printed and used during a patient encounter. Here are the steps involved in using the template:

Step 1: Download the template

You can download and print Spurling's Test template. It should be prepared for usage during patient interaction.

Step 2: Fill out patient information

The template often includes fields for patient data, such as name, date of birth, and medical record number. Before starting the examination, fill out this form with the patient.

Step 3: Perform the test

Observe the steps required to do the test. Apply pressure to the top of the patient's head while slowly rotating, extending, and laterally flexing the neck. Keep track of any discomfort, tingling, numbness, or weakness during the maneuver.

Step 4: Interpret the results and develop a care plan

Once the test is completed, record the interpretation of the results. Indicate whether the test was positive or negative, and note any other relevant findings. Develop a care plan for the patient based on the test results. This plan may include further diagnostic studies, imaging, or referral to a specialist.

Step 5: Store the document

Spurling's Test template should be finished, signed, and dated before filing in the patient's medical file. It is crucial to record the results precisely and legibly for future reference.

Scoring

The Spurling test is a physical examination maneuver rather than a formal one. Hence, it does not have a set scoring system. The examiner's clinical judgment and observation are used to interpret the findings. If the patient feels pain, numbness, tingling, or weakness during the test and it is replicated during the maneuver, the nerve root is crushed. This is often regarded as a favorable finding and may point to a cervical spine issue.

It is important to remember that a positive test alone cannot confirm cervical spine disease; the results must be assessed alongside the patient's medical history, physical examination, and imaging tests.

When to use this assessment?

Spurling's assessment is a screening tool healthcare providers use to identify nerve root compression in the cervical spine. The test is typically used in patients with symptoms of cervical radiculopathies, such as neck pain, shoulder pain, arm pain, or weakness.

Here are some situations where Spurling's assessment may be appropriate:

• Suspected cervical radiculopathy: When a patient exhibits cervical radiculopathy symptoms such as neck discomfort, shoulder pain, arm pain, or weakness, Spurling's examination is frequently performed. If a medical professional suspects the patient has this illness, the test may be used to confirm the diagnosis.
• History of cervical spine injury: If the patient has a history of cervical spine damage, such as a herniated disc or spinal stenosis, the healthcare professional may use Spurling's Test to determine the severity of nerve root compression and the best course of action.
• Unexplained neck or arm pain: If the patient complains of unexplained neck or arm pain, the healthcare professional may utilize Spurling's Test to rule out or confirm cervical spine problems as the underlying cause.
• Post-surgical evaluation: The medical professional may use Spurling's Test to evaluate the patient's nerve root function following cervical spine surgery and identify any remaining nerve root compression necessitating additional care.
• Follow-up evaluation: Healthcare professionals may use Spurling's Test during follow-up exams on patients who have already been diagnosed with cervical spine disorders to track the disease's development and modify the treatment strategy as necessary.

It is essential to note that a positive Spurling's Test alone is not enough to diagnose a cervical spine condition. Further imaging studies, such as X-rays, MRI, or CT scans, may be necessary to confirm the diagnosis.

Benefits of a free Spurling's Test template

Spurling's Test is one of the most common provocative tests professionals use. A template you can access and fill out quickly will make your practice more efficient. Here are the benefits of using Spurling's Test template:

• Standardization: The template offers standardized exam methods, guaranteeing uniform and trustworthy outcomes among healthcare practitioners.
• Organization: The template organizes the test results documentation, making it simple for other healthcare professionals engaged in the patient's care to review and communicate the data.
• Time-saving: The template can save healthcare providers time by offering a pre-formatted document that can be swiftly filled out during patient evaluations.
• Improved accuracy: Healthcare providers can improve the accuracy of their diagnoses and treatment plans by following a standardized procedure and documenting the results.
• Increased efficiency: The template can make healthcare providers' jobs easier by eliminating the need for manual documentation and data entry.
• Accessibility: Healthcare professionals can quickly and affordably use the free Spurling's Test template by downloading and printing it from various online sources.

Regularly update your patient's data to provide them with the best treatment options and care plans.

Examination and treatment of cervical spine disorders

Examining and treating cervical spine disorders are crucial for identifying the cause of neck pain and related symptoms. Proper diagnosis helps plan effective treatment, relieving pain, improving mobility, and preventing further complications. Timely intervention can significantly enhance a patient's quality of life and overall health.

Examination of cervical spine disorders

Professionals ask about patient symptoms and medical history to examine cervical spine disorders. Here are some salient steps or procedures that help in examining disorders:

1. Obtain patient history

Obtain a detailed medical history, including the onset, duration, and characteristics of symptoms. Inquire about any trauma, previous spinal surgeries, or relevant medical conditions and record these in a cervical compression test document, such as the one provided for free below!

2. Conduct a physical examination

Evaluate the patient's cervical spine alignment and assess for any abnormal curvature. Test both active and passive cervical range of motion (ROM), noting any restrictions or pain. Assess motor strength, sensory function, and reflexes in the upper extremities, and palpate the cervical spine for tenderness, muscle spasms, or swelling.

3. Perform special tests

Extend, rotate, and laterally bend the neck to assess for cervical nerve root compression through Spurling's Test, which helps in diagnosing radiculopathy or nerve root irritation. Lhermitte's Sign evaluates for cervical cord irritation by passively flexing the patient's neck. This test can help identify conditions such as multiple sclerosis or cervical myelopathy.

4. Utilize imaging studies

Utilize X-rays to identify fractures, dislocations, or degenerative changes, MRI for detecting soft tissue abnormalities like disc herniations or spinal stenosis, and CT scans for detailed visualization of bone structures, especially in complex fracture cases. These imaging studies provide essential diagnostic information for comprehensive evaluation and treatment planning.

Treatment of cervical spine disorders

Treatment plans are tailored based on the specific diagnosis, severity of symptoms, and individual patient characteristics. Here are some of the treatments or interventions for cervical spine disorders:

• Physical therapy: Focus on exercises to improve posture, strengthen muscles, and enhance range of motion.
• Pain management: Non-steroidal anti-inflammatory drugs (NSAIDs) or muscle relaxants may be prescribed to alleviate pain and inflammation.
• Heat and cold therapy: Applying heat or cold packs can help reduce pain and muscle spasms.
• Analgesics: Over-the-counter or prescription pain relievers can be used for pain management.
• Corticosteroids: Oral or injectable steroids may be prescribed for their anti-inflammatory effects in cases of acute inflammation.
• Soft collars: Short-term use of soft cervical collars may provide support and restrict movement during the acute phase of injury.
• Epidural steroid injections: For targeted delivery of anti-inflammatory medication to alleviate nerve root inflammation.
• Facet joint injections: Address pain arising from the facet joints of the cervical spine.
• Discectomy: Removal of a herniated disc that is compressing a nerve root.
• Foraminotomy: Widening of the neural foramen to relieve pressure on nerve roots.
• Spinal fusion: In cases of instability, fusion of vertebral segments may be performed.
• Postoperative physical therapy: Essential for restoring strength, flexibility, and function after surgical procedures.
• Home exercises: Prescribed to maintain spinal health and prevent recurrence.
• Ergonomics: Emphasize proper posture and ergonomics, especially for those with desk jobs.
• Weight management: Excess weight can contribute to cervical spine strain; weight management may be advised.

A multidisciplinary approach involving orthopedic specialists, neurologists, and physical therapists is often beneficial in effectively managing cervical spine disorders.

References

Jones, S. J., & Miller, J.-M. M. (2020). Spurling test. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK493152/

Shelow, J., Krug, T., Homol III, T., Nigro, V., O'Neal, C., & Holbein-Jenny, M. A. (2020, June 7). Spurling Test, Maximal Cervical Compression Test, Foraminal Compression Test, Neck Compression Test, Quadrant Test. American Physical Therapy Association. https://www.apta.org/patient-care/evidence-based-practice-resources/test-measures/spurling-test#

The University of West Alabama Athletic Training & Sports Medicine Center. (n.d.). Spurling's Test. Retrieved May 27, 2024, from http://at.uwa.edu/special%20tests/specialtests/upperbody/spurling.htm