The Spurling test help in diagnosing cervical radiculopathy (cervical nerve root compression or irritation). Now lets us discuss the term “Cervical Radiculopathy”. This test is also known as the foraminal compression test.
What is Cervical Radiculopathy?
Cervical radiculopathy is a condition commonly known as “pinched nerve”. It occurs when the nerve in the neck is irritated or compressed when it branches off from the spinal cord.
In our neck region, there are a total of seven vertebrae and eight pairs of cervical nerves. These Cervical nerves are the branches from the spinal cord which run through the vertebrae. These Cervical nerves are named from C1 to C8 and they originate from both sides of the spinal cord through the vertebral foramen which is the space between two adjacent vertebrae.
The point of origin of the nerve from the spinal cord is known as the root of the nerve. Now the cervical nerves are named in order of the cervical vertebrae just below them. For example, the C6 nerve root runs above the pedicle of the C6 vertebrae, C7 nerve root above the pedicle of the C7 vertebrae. As there is no C8 vertebrae but there is a C8 nerve so the C8 nerve runs above the pedicle of the T1 vertebrae and the T1 nerve root runs below the T1 pedicle.
These Cervical nerves then go on to supply the muscles and joints of the shoulders, arms, wrist, etc., and provide them nervous stimulation for various actions.
Sometimes the root of the cervical nerve may get compressed, or what is otherwise known as pinching of the nerve root. This pinching or compression of the nerve root is known as cervical radiculopathy and it can occur due to various causes.
Causes of Cervical Radiculopathy
There could be multiple reasons that can cause Cervical Radiculopathy (compression of the cervical nerve root). Some reasons include
- Degenerative changes (Wear and Tear Changes) – This can lead to disc bulging or disc herniation, formation of bone spur, etc
- Sudden Injury – In younger individuals, it is most often caused by a sudden injury that results in a disc herniation.
Degenerative Changes (Wear and Tear changes)
The major cause for the pinching of the cervical nerve roots is degenerative changes (wear and tear changes). As we age, the intervertebral disk losses height and begin to bulge. They also lose their water content, start to dry out, and become stiffer. This can lead to the collapse of disk spaces, and a decrease in the height of the disk space.
As the intervertebral disk loses there height, the vertebrae move closer. The body reacts to the collapsed disc by creating more bone around the disk, also known as bone spurs. The bone spurs lead to the stiffening of the spine.
Bone spurs may also narrow the foramen – the tiny openings that are on both sides of the spinal column, from which the nerve root exits. These bone spurs pinch the nerve root.
Disks with degenerative changes are commonly referred to as arthritis or Spondylosis. These changes are normal and occur across all people. 50% of middle-aged and older people suffer from pinched or compressed nerves that don’t cause painful symptoms. It is still unclear that why some people experience symptoms while others do not.
A disk herniates when its nucleus (jelly-like core) pushes against its outer ring (annulus). If the disc is injured or when the disc degeneration becomes chronic the nucleus may squeeze all the way through.
When the herniated disc bulges outward towards the spinal canal. It exerts pressure on the nerve roots, which causes weakness and pain in the area where the nerve supplies. A herniated disc most commonly occurs while lifting, bending, pulling, or twisting movements.
Signs And Symptoms of Cervical Nerve Root Compression
These nerves supply mostly the muscles and joints of the shoulders, arms, wrists, etc along with their dermatomes. Pinching of these nerves would cause a neurological deficit. This can lead to loss of functionality of these muscles or muscle weakness and pain along with the loss of sensation from the skin.
For example – The same nerve originating from the cervical region supplies the muscles of the cervical, shoulder, and arm regions. Its compression would cause radiating pain from the neck to the shoulder and the arms.
How The Patient Will Come To The Doctor?
The patient will come to the doctor with the complaint of neck pain. Now it is quite common that if some have suffered an injury in the knee. To find out the diagnosis, the doctor will the perform physical examination tests and radiological tests related to the knee.
So here in this case also when the patient will come to the doctor with the complaint of neck pain. To find out the diagnosis, the doctor will perform the appropriate physical examination tests and radiological tests related to the neck.
Therefore, to rule out the possibilities of cervical radiculopathy, the doctor will perform the Spurling’s test or Foraminal Compression test. Therefore along with the Spurling test, the doctor may order other diagnostic tests like the modern CT or MRI for better diagnosis. But for the initial approach, the Spurling test is the test of choice.
What Is Spurlings Test?
Roy Spurling, who was a neurosurgeon created this test to test for neck pain. The Spurling test is a provocative type of test and it is used to examine or test your cervical spine. A provocative test places pressure on the body to get a response or reproduce the symptoms. It has mild to moderate sensitivity
The Spurling test works by compressing the affected nerve root. In this way, cervical radiculopathy can be ruled out.
How to Perform The Spurlings Test/Maneuver?
There are many variations of this test, but the simplest and easiest way to perform the Spurling test/maneuver is
- Initially, the patient sits up straight while the doctor stands just behind him.
- Now the doctor asks the patient to laterally flex his head towards the affected side (painful side). Or the doctor laterally flexes the patient’s head towards the affected side (painful side).
- After that, the doctor interlocked his hands and places his interlocked hands over the top of the patient’s head.
- Now the doctor applies a downward compressive force (axial loading) to the top of the patient’s head.
What these steps do is that they compress the opening of the nerves ie narrowing of the neural foramina. Neural foramina is the place in the spinal cord from where these cervical nerves pass through the spinal cord. That’s why this test is also known as the foraminal compression test.
Positive Spurling Test
Reproduction of the symptoms or pain radiating down towards the patient’s arm indicates a positive Spurling test. The doctor will end the test as soon as you experience the pain.
A positive Spurling test indicates nerve problems such as a pinched nerve. Before confirming the diagnosis and suggesting treatment, the doctor will also consider the result of other diagnostic tests such as MRI or CT scans or nerve conduction studies.
Thus the patient is diagnosed to have a pinched nerve root and for the confirmation of the diagnosis further tests are recommended (MRI or CT Scan or nerve conduction studies). Doctors use the Spurlings test in conjunction with other tests to confirm a diagnosis.
In contrast, the compression will be named based on the cervical nerve root being compressed. For example, If the C4 nerve root is compressed then it will be called C4 nerve root compression or C4 radiculopathy. If the C6 nerve root is compressed then it will be called C6 nerve root compression or C6 Radiculopathy.
Negative Spurling Compression test
A negative Spurling Test means you’ll not feel any pain during the test. However, a negative Spurling test doesn’t always mean that you don’t have cervical radiculopathy.
After a negative test result, your doctor may order some additional tests to check, if there are other indications of cervical radiculopathy or other conditions that could be the cause of the symptoms you are experiencing.
Some of these tests include
Upper Limb tension Test
There are many upper limb tension tests that are designed to put tension on the nerves that run from your neck down to your arm. While performing these upper limb tension tests, each nerve is stressed to see if the patient’s symptoms are reproduced.
Shoulder Abduction Test
This test is performed by placing the palm of your affected arm on the top of your head. If the symptoms disappear when you do this, it is considered a positive result.
Your doctor might order CT scans, MRIs, or X-rays to get a closer look at the area that is affected. This can help them to rule out or determine any other cause of your pain, like injuries.
Nerve Conduction Studies
These tests measure how fast a nerve impulse travels through your nerve. In contrast, this will help your doctor to identify or determine the nerve injury.
Accuracy of the Test
There is no doubt that this test is one of the most commonly used tests for diagnosing pinched or compressed nerve roots. This test has high specificity but low sensitivity.
Specificity refers to how accurately a test rules out or excludes the condition. This test has a specificity of 93%.
Sensitivity means how accurately a test can identify or diagnose the condition. This test has a sensitivity of 30 to 50%.
Due to low sensitivity, this test may not be useful for screening pinched or compressed nerves. It can be used by doctors alongside other diagnostic tests such as an MRI, CT scan, or nerve conduction studies. This can help confirm a diagnosis.
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