Athletic Training & Sports Medicine Center

  

Examination Links:

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Spurling's Test
Examination type Neurological
Patient & Body Segment Positioning The patient can be short sitting on an examination table, lying supine on an examination table, or seated in a chair.
Examiner Position If the patient is short sitting on an examination table, the examiner should kneel on the table 8 to 10 inches behind the patient. If the patient is seated in a chair, the examiner should be standing beside or behind with the arms slightly flexed and both hands resting on top of the patient’s head. The elbows should be roughly eye level to the patient. If the patient is supine, then the examiner should be seated with the patient’s head 6 to 8 inches in front of the examiner’s chest. The examiner should support the head and neck completely with one hand and the other should be placed on top of the head.
Performing the Test Begin by performing the basic cervical compression test for the neck. First tell the athlete that you are going to be placing increasing pressure on their head, and ask them to inform you when it begins to hurt and what type of pain and sensations are felt. The patient should be looking directly ahead with the head in neutral (no flexion, extension, or rotation). If pain results or a numb, tingling, or other noticeable sensation radiates down the arm, stop the test immediately as this is a positive sign for nerve root compression. If no pain is felt with the basic cervical compression test then the examiner can progress to the Spurling’s Compression Test. First place the neck into extension and compress the head downward along the long axis.  Next, rotate the head to either side while still extended and apply compression. Finally, place the head in extension, rotation, and lateral flexion then press downward again. After placing the neck into the each position, place the hands on top of the head again and begin to compress straight down, with slightly increasing pressure.
Tissues Being Tested cervical nerve roots
Positive Test Pain felt in the arm on the same side that the head is flexed during compression. As soon as pain is felt the test should be stopped; the test should not be continued long enough to “rate” the pain.  Severity of the compression of the nerve root is best measured by location of the pain.  For example, is it just pain in the neck, or pain in the neck and shoulder, or pain in the neck, shoulder, and arm with radiating abnormal sensation.
Interpretation A positive test indicates that one or more of the nerve roots coming from the cervical spine is being compressed by a fractured or displaced vertebrae, swelling, scar tissue, prolapsed or herniated vertebral disk, or by severe muscle spasm. Spurling’s tests for nerve root involvement in a cervical spine injury.
Common errors in performing exam Remember: Passive tests are more dangerous than active tests when used on the spine due to a risk of an unstable vertebral column. Use extreme caution when performing this test. Pay close attention to what you are doing and keep the athlete’s safety in mind. Do not be afraid to cause a little discomfort of the athlete to find out what is ultimately causing their pain, but never cause further harm.
Factors possibly resulting in misinterpretation Muscle or ligamentous injuries to the same area can cause misinterpretation. The Reverse Spurling’s test will aid in the correction of this common mistake.  An increase in pain with this test indicates the injury may be a muscle injury caused by stretching the injured muscle. A decrease or alleviation of the pain with this test indicates a releasing of the pressure on a compressed nerve root.
Related tests Reverse Spurling’s Test (Cervical Distraction test)
References

 Booher & Thibodeau. Athletic Injury Assesment. Fourth Ed. MeGraw Hill Higher Ed. McGraw Hill Companies, INC. New York, NY 10020. Copyright 2000.
Links: http://www.aafp.org/afp/20000515/3079.html
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