Neck Orthopaedic Test: Cervical Quadrant Test

The Cervical Quadrant Test is a cervical spine special test that combines extension, side flexion and rotation, often with gentle axial compression, to reproduce neck or upper-limb symptoms. It is commonly used to support assessment reasoning around cervical radiculopathy, foraminal-closing sensitivity or extension-rotation-sensitive neck pain.

A positive finding may include reproduction of familiar neck, shoulder, arm or hand symptoms, especially symptoms that follow the client’s typical referral pattern. However, the test does not confirm cervical radiculopathy or nerve root compression on its own. It should be interpreted alongside history, neurological screening, cervical range of motion, upper-limb neurodynamic testing, symptom behaviour and other assessment findings.

Introduction

The Cervical Quadrant Test is commonly used in cervical spine assessment when symptoms may be influenced by extension, rotation or foraminal-closing positions. It is often taught alongside, or as a variation of, Spurling’s Test, cervical foraminal compression testing or neck compression testing.

The test places the neck into a combined position that may reduce space around the intervertebral foramen on the tested side. When symptoms are reproduced, especially arm pain, paraesthesia or familiar referral, the result may support suspicion that cervical nerve root sensitivity is relevant to the presentation.

However, the test must be interpreted carefully. Neck pain, shoulder pain, upper-limb symptoms and neurological symptoms can have many contributors. The Cervical Quadrant Test is not designed to confirm a diagnosis on its own and should not replace a structured assessment.

For Measurz, the value of the test is in consistent recording: side tested, neck position, whether compression was used, symptom location, pain score, neurological symptoms, familiar symptom reproduction, stopping reason and related findings.

Quick Summary

Test name: Cervical Quadrant Test
Common related names: Spurling’s Test, foraminal compression test, neck compression test
Region: Cervical spine, shoulder and upper limb
Primary purpose: Assess symptom response to cervical extension, side flexion and rotation, with or without compression
Commonly associated presentation: Cervical radiculopathy-type symptoms or foraminal-closing sensitivity
Positive finding: Familiar neck, shoulder, arm or hand symptoms reproduced during the test
Negative finding: No familiar symptoms and no meaningful side-to-side symptom reproduction
Main limitation: The test does not confirm or exclude cervical radiculopathy on its own.

What Is the Cervical Quadrant Test?

The Cervical Quadrant Test is a neck special test that moves the cervical spine into a combined position of:

• Extension
• Side flexion
• Rotation

Depending on the variation, gentle axial compression may also be added.

The test is usually performed toward the symptomatic side, but both sides may be assessed for comparison. A positive response is typically based on reproduction of familiar symptoms, especially symptoms that travel into the shoulder, arm or hand.

The test can be used as a symptom provocation test, but it should not be used as a stand-alone diagnostic test.

Why It Is Used

The Cervical Quadrant Test may be used to support assessment reasoning around:

• Cervical radiculopathy-type symptoms
• Foraminal-closing sensitivity
• Neck pain with referral into the shoulder or arm
• Upper-limb paraesthesia or altered sensation
• Extension-rotation-sensitive neck pain
• Side-to-side cervical symptom comparison
• Whether further neurological assessment may be appropriate
• Baseline and retest documentation in Measurz

The test is useful because it can reproduce familiar symptoms in a controlled way. It is most meaningful when combined with neurological screening and other cervical radiculopathy tests.

What It Assesses

The Cervical Quadrant Test assesses symptom response to a combined cervical closing position.

It may provide information about:

• Neck symptom reproduction
• Shoulder or arm symptom reproduction
• Familiar referral pattern
• Side-to-side symptom difference
• Extension and rotation sensitivity
• Possible foraminal-closing sensitivity
• Cervical irritability
• Need for further assessment

It does not directly assess:

• Nerve root compression with certainty
• Disc pathology with certainty
• Imaging findings
• Cervical joint pathology with certainty
• Muscle strength
• Upper-limb function
• Tissue healing
• Readiness for sport or work
• Treatment requirement

Who It Is Useful For

The Cervical Quadrant Test may be useful for clients with:

• Neck pain
• Neck pain with arm symptoms
• Shoulder or arm symptoms that may be cervical-related
• Paraesthesia, tingling or altered sensation requiring assessment
• Symptoms worsened by neck extension or rotation
• Reduced cervical range of motion
• Cervical radiculopathy-type presentation
• A need for baseline and retest documentation

It may also be useful for professionals learning how cervical position influences symptom referral.

When to Use This Test

Consider using the Cervical Quadrant Test when:

• Cervical radiculopathy-type symptoms are part of the assessment reasoning
• The client reports symptoms into the shoulder, arm or hand
• Symptoms appear influenced by neck position
• Cervical extension or rotation is relevant
• You need to compare left and right symptom response
• You have already screened for safety, irritability and neurological concerns
• You are building a broader cervical assessment profile

It should generally be used alongside neurological screening, cervical range of motion, distraction testing and upper-limb neurodynamic tests where relevant.

When Not to Use or When to Be Cautious

Use caution or avoid the test when:

• Red flag features are present
• There is recent significant trauma
• Cervical fracture, instability, infection, cancer or inflammatory pathology is suspected
• Severe neurological symptoms are present
• Symptoms are rapidly worsening
• The client has signs of cervical myelopathy
• Dizziness, drop attacks or vascular-type symptoms are reported
• Cervical extension or compression is highly irritable
• The professional cannot perform the test safely

Stop immediately if symptoms increase sharply, neurological symptoms worsen, dizziness occurs, the client feels unsafe, or the client asks to stop.

Equipment Required

The Cervical Quadrant Test usually requires no equipment.

Optional equipment includes:

• Measurz app
• Pain rating scale
• Neurological screen record
• Cervical range of motion tool
• Notes field for symptom location, side, compression and stopping reason
• Video recording for education only where appropriate

Step-by-Step Protocol / Practice

Setup

Explain the test before performing it.

A useful explanation is:

“I am going to gently guide your neck into a combined position and ask whether it reproduces your familiar symptoms. Tell me immediately if you feel arm symptoms, tingling, dizziness, sharp pain or anything concerning.”

Decide whether you will perform the test:

• Without compression first
• With gentle compression only if appropriate
• Seated
• Standing
• Toward the symptomatic side
• Bilaterally for comparison

Record the variation used.

Client position

The client may sit upright or stand, depending on the setting and safety.

For most assessment situations, seated is preferred because it provides better control.

The client should:

• Sit tall
• Keep shoulders relaxed
• Keep eyes open
• Report symptoms clearly
• Avoid forcing the neck independently

Examiner/professional position

The professional stands behind or slightly beside the client.

The professional should be able to guide the head and neck safely, monitor symptoms and stop the test quickly.

Hand placement

Place both hands gently around the head and upper cervical region.

Avoid gripping tightly or applying sudden force.

If compression is used, it should be gentle, controlled and applied only after positioning is tolerated.

Stabilisation

The trunk should remain still.

Do not force the shoulders down or aggressively stabilise the body. The goal is controlled symptom assessment, not maximal range.

Movement or force direction

Guide the cervical spine into:

1. Extension
2. Rotation toward the test side
3. Side flexion toward the test side

If appropriate, apply gentle axial compression downward through the head and cervical spine.

The test should be slow and controlled.

Instructions

Tell the client:

“Let me guide the movement. Tell me if this reproduces your familiar symptoms and exactly where you feel them. Let me know immediately if symptoms travel into the arm or if you feel dizzy or unwell.”

Positive finding

A positive finding may include:

• Familiar neck symptoms reproduced
• Familiar shoulder, arm or hand symptoms reproduced
• Paraesthesia or tingling reproduced in the client’s usual pattern
• Reproduction of familiar radiating symptoms
• Clear side-to-side difference
• Symptoms increased by compression
• Symptoms that match the clinical history

The symptom location and quality must be recorded.

Negative finding

A negative finding may include:

• No familiar symptoms
• No arm or hand symptoms
• No meaningful side-to-side difference
• Only mild local stretch or non-familiar discomfort
• No relevant symptom reproduction

A negative finding does not fully exclude cervical radiculopathy or other cervical involvement.

Stopping criteria

Stop the test if:

• Arm symptoms increase sharply
• Neurological symptoms worsen
• Dizziness, nausea or visual disturbance occurs
• The client reports severe pain
• The client asks to stop
• The professional feels the test is unsafe
• Symptoms do not settle appropriately

Safety notes

Do not perform the test aggressively. Avoid bouncing, sudden compression or forcing end range. Safety screening is essential before cervical compression tests.

Positive and Negative Test Interpretation

A positive Cervical Quadrant Test may increase suspicion that cervical positioning contributes to the client’s symptoms. If the test reproduces familiar arm symptoms, tingling or referral in a pattern consistent with the history, it may support assessment reasoning around cervical radiculopathy-type involvement.

However, a positive test does not confirm cervical radiculopathy, foraminal stenosis, disc pathology or nerve root compression. Symptoms can be influenced by joints, muscles, neural tissues, irritability, fear, guarding or other cervical and shoulder contributors.

A negative Cervical Quadrant Test may reduce suspicion that this cervical closing position is a major symptom driver, particularly when other radiculopathy tests are also negative and the neurological screen is reassuring. However, a negative result does not fully exclude cervical radiculopathy or other cervical contributions.

The finding is more meaningful when interpreted with:

• History
• Symptom distribution
• Neurological screen
• Reflexes, sensation and myotomes
• Cervical range of motion
• Distraction Test
• Upper Limb Neurodynamic Test
• Shoulder Abduction Relief Test
• Shoulder assessment
• Functional and work/sport demands
• Imaging or referral findings where relevant

Sensitivity, Specificity and Diagnostic Accuracy

Diagnostic accuracy varies depending on the exact version of the test, population and reference standard.

Recent systematic review evidence for physical examination tests in painful cervical radiculopathy reported that versions of Spurling’s Test had:

Condition or presentation: Painful cervical radiculopathy
Population: Adults with suspected cervical radiculopathy across diagnostic studies
Test variation: Spurling’s Test / foraminal compression / cervical quadrant-type variations
Reference standard: Varied across studies, including imaging, electrodiagnostic testing and clinical reference standards
Sensitivity: Reported range approximately 0.38 to 0.98
Specificity: Reported range approximately 0.84 to 1.00
Positive likelihood ratio: Generally more useful when specificity is high, but varies by study
Negative likelihood ratio: Variable; a negative test does not confidently exclude cervical radiculopathy on its own
Key limitations: Different test variations, reference standards, populations and certainty of evidence.

Plain-language interpretation:

• Higher specificity means a positive test may increase suspicion when symptoms match the history.
• Variable sensitivity means a negative test should not be used alone to exclude cervical radiculopathy.
• The test is more useful when combined with neurological screening and other cervical radiculopathy tests.
• The result should be recorded as symptom provocation, not as diagnostic confirmation.

Reliability and Validity

Reliability depends on standardising the exact test variation.

Reliability may be affected by:

• Seated versus standing position
• Amount of extension
• Amount of rotation
• Amount of side flexion
• Whether compression is used
• Compression force
• Client irritability
• Definition of a positive result
• Whether local neck pain or arm symptoms are counted
• Professional experience

Validity is stronger when the test is interpreted as one part of a cervical radiculopathy cluster. It is weaker when used alone to identify a specific structure or condition.

Reliability improves when the professional records:

• Version used
• Side tested
• Compression used or not used
• Symptom location
• Neurological symptoms
• Pain score
• Familiarity of symptoms
• Reason for stopping
• Comparison side

Common Errors and Limitations

Common errors include:

• Applying compression too early
• Applying excessive force
• Moving too quickly
• Not screening for red flags or neurological concerns
• Not recording symptom location
• Counting non-familiar local neck discomfort as a clear positive
• Ignoring dizziness or vascular-type symptoms
• Not comparing sides
• Using the test as a stand-alone diagnosis
• Not combining with neurological examination

Limitations include:

• Test names and variations differ
• Diagnostic accuracy varies widely
• Compression may be inappropriate for some clients
• Negative results do not exclude radiculopathy
• Local neck pain is less specific than familiar arm symptoms
• A single positive result does not confirm nerve root compression
• Symptoms may be influenced by shoulder or upper-limb conditions

Practical Applications

The Cervical Quadrant Test may be useful for:

• Cervical radiculopathy-type assessment reasoning
• Recording cervical closing-position symptom response
• Comparing left and right cervical symptoms
• Supporting neurological screen interpretation
• Deciding whether further assessment is needed
• Client education about symptom-provoking positions
• Baseline and retest documentation in Measurz

In Measurz, it can be recorded alongside cervical range of motion, neurological screen, Distraction Test, Upper Limb Neurodynamic Test, Shoulder Abduction Relief Test, shoulder tests and functional assessment.

How to Record This in Measurz

Record:

• Test name: Cervical Quadrant Test
• Related variation: Spurling/foraminal compression if used
• Side tested
• Position: seated or standing
• Compression used: yes or no
• Result: positive, negative, unclear or unable to test
• Pain score
• Symptom location
• Symptom quality
• Arm or hand symptoms
• Neurological symptoms
• Whether symptoms were familiar
• Direction tested
• Irritability
• Reason for stopping if relevant
• Comparison side
• Related neurological findings
• Confidence in interpretation
• Further assessment or referral notes if appropriate
• Retest date if relevant

Recording these details improves repeatability, communication, client education, assessment reasoning, monitoring over time, team consistency and reporting quality.

Related Tests / Internal Links

• Cervical Distraction Test
• Spurling’s Test
• Upper Limb Neurodynamic Test
• Shoulder Abduction Relief Test
• Cervical Range of Motion
• Neurological Screen
• Shoulder assessment
• AC Shear Test
• Drop Arm Test
• Scapular Assistance Test

FAQs

Is the Cervical Quadrant Test the same as Spurling’s Test?

They are closely related and often overlap. Both use cervical extension, side flexion and rotation, with some versions adding compression.

What is a positive Cervical Quadrant Test?

A positive finding may include reproduction of familiar neck, shoulder, arm or hand symptoms, especially if symptoms match the client’s typical referral pattern.

Does a positive test diagnose cervical radiculopathy?

No. It may increase suspicion, but it does not confirm cervical radiculopathy on its own.

Does a negative test exclude cervical radiculopathy?

No. Sensitivity varies, so a negative test does not fully exclude cervical radiculopathy.

Should compression always be used?

No. Compression should only be used when appropriate and after the position is tolerated.

What symptoms are most important?

Familiar arm symptoms, paraesthesia or referral patterns are usually more meaningful than vague local neck discomfort.

When should the test be stopped?

Stop with sharp pain, worsening neurological symptoms, dizziness, visual symptoms, nausea, distress or if the client asks to stop.

What should it be combined with?

History, neurological screening, cervical range of motion, Distraction Test, Upper Limb Neurodynamic Test and shoulder assessment.

Key Takeaways

The Cervical Quadrant Test assesses symptom response to cervical extension, rotation and side flexion.

It overlaps with Spurling’s Test and foraminal compression variations.

A positive test may increase suspicion of cervical radiculopathy-type involvement when symptoms match the history.

A negative test does not fully exclude cervical radiculopathy.

Diagnostic accuracy varies across studies and test variations.

Measurz recording should include side, position, compression, symptom location, neurological symptoms and comparison side.

References

Childress, M. A., & Becker, B. A. (2016). Nonoperative management of cervical radiculopathy. American Family Physician, 93(9), 746–754.

Lin, L. H., Lin, T. Y., Chang, K. V., Tzang, C. C., Wu, W. T., & Özçakar, L. (2025). Diagnostic performance of Spurling’s test for the assessment of sub-acute and chronic cervical radiculopathy: A systematic review and meta-analysis. American Journal of Physical Medicine & Rehabilitation, 104(8), 717–723.

Rubinstein, S. M., Pool, J. J. M., van Tulder, M. W., Riphagen, I. I., & de Vet, H. C. W. (2007). A systematic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy. European Spine Journal, 16(3), 307–319. https://doi.org/10.1007/s00586-006-0225-6

Thoomes, E. J., van Geest, S., van der Windt, D. A. W. M., Falla, D., Verhagen, A. P., Koes, B. W., & Thoomes-de Graaf, M. (2026). Diagnostic accuracy of physical examination tests for painful cervical radiculopathy: Update of a systematic review and meta-analysis. BMC Musculoskeletal Disorders.

Viikari-Juntura, E. (1989). Interexaminer reliability of observations in physical examinations of the neck. Physical Therapy, 69(2), 152–156.