### Date : 2024-06-16 13:25 ### Topic : Spurling's Test - check cervical radiculopathy #medicine #orthopedic ---- ### Spurling's Test Overview **Spurling's test** is a clinical test used to diagnose **cervical radiculopathy**, which is a condition where a nerve root in the cervical spine is compressed, causing pain, numbness, or weakness radiating from the neck down into the arm. <iframe title="Spurling's Test | Cervical Radicular Syndrome" src="https://www.youtube.com/embed/3ZSNdv0o0yk?feature=oembed" height="113" width="200" allowfullscreen="" allow="fullscreen" style="aspect-ratio: 1.76991 / 1; width: 100%; height: 100%;"></iframe> ### Purpose The purpose of Spurling's test is to reproduce the patient's symptoms of nerve root compression by compressing the cervical spine and to help confirm the diagnosis of cervical radiculopathy.  <Photo from: https://www.osmosis.org/learn/Spurling_test> Thx. Osmosis! ### Indications Spurling's test is indicated for patients presenting with: - Neck pain radiating into the arm - Numbness, tingling, or weakness in the arm - Suspected cervical radiculopathy ### Procedure **Positioning:** - Have the patient sit comfortably on an examination table or chair. **Steps:** 1. **Initial Position:** Ask the patient to extend their neck (tilt the head backward). 2. **Lateral Flexion:** Have the patient laterally flex their neck (tilt the head to the side of the pain or symptoms). 3. **Axial Compression:** Gently apply downward pressure on the top of the patient's head. **Alternative Positions:** - If symptoms are not elicited in the initial position, the test can be repeated with the neck in slight rotation or in a neutral position. ### Interpretation - **Positive Spurling's Test:** The test is considered positive if the patient's radicular pain or symptoms are reproduced during the maneuver. This suggests cervical nerve root compression or irritation, often due to conditions like a herniated disc, cervical spondylosis, or foraminal stenosis. - **Negative Spurling's Test:** If the test does not reproduce the patient's symptoms, cervical radiculopathy is less likely, but it does not entirely rule out the condition. ### Example Case Study **Patient Profile:** - **Name:** Jee Hoon Ju - **Age:** 35 - **Occupation:** Computer Programmer **Medical History:** - **Symptoms:** Jee Hoon Ju reports neck pain that radiates down his right arm, accompanied by numbness and tingling in the fingers. The symptoms worsen with certain neck movements and when working at the computer for long periods. **Physical Examination:** - **Neck Range of Motion:** Slightly limited, with pain on extension and right lateral flexion. - **Neurological Exam:** Decreased sensation in the right arm, particularly in the C6 dermatome. **Spurling's Test:** 1. **Neck Extension:** The patient's neck is extended. 2. **Right Lateral Flexion:** The patient's neck is tilted to the right side. 3. **Axial Compression:** Downward pressure is applied on the top of the patient's head. 4. **Result:** The patient reports an increase in radicular pain down the right arm. **Interpretation:** - The positive Spurling's test suggests cervical radiculopathy, likely due to nerve root compression. ### Management 1. **Conservative Treatment:** - **Rest and Activity Modification:** Avoid activities that exacerbate symptoms. - **Physical Therapy:** Exercises to strengthen neck muscles, improve posture, and increase flexibility. - **Medications:** NSAIDs for pain and inflammation, muscle relaxants if muscle spasms are present. 2. **Advanced Treatment:** - **Corticosteroid Injections:** To reduce inflammation and pain. - **Surgery:** In severe cases or when conservative treatment fails, surgical options like cervical decompression or discectomy may be considered. 3. **Follow-Up:** - Regular follow-up to monitor symptoms and adjust treatment as needed. - Imaging studies (MRI or CT scan) if symptoms persist or worsen. ### Conclusion Spurling's test is a valuable diagnostic tool for identifying cervical radiculopathy by reproducing nerve root compression symptoms. A positive test helps confirm the diagnosis and guides further management, including conservative treatments and potential advanced interventions for conditions like cervical disc herniation or spondylosis.