Spurling’s Test is a cervical symptom provocation test commonly used when cervical radicular symptoms are suspected. It typically combines cervical extension, lateral flexion, rotation and gentle axial compression while monitoring for reproduction of familiar arm symptoms. A positive test may increase suspicion of cervical radicular involvement when it reproduces familiar radiating arm pain or paraesthesia, especially when supported by neurological findings and other cervical tests. The test does not confirm cervical radiculopathy or nerve root compression on its own, and a negative result does not fully exclude radicular involvement.

Introduction

Spurling’s Test is one of the best-known cervical orthopaedic tests for people with neck pain and arm symptoms. It is designed to narrow the cervical foraminal region and provoke symptoms associated with cervical radicular presentations. The test is commonly used when a client reports radiating arm pain, paraesthesia, numbness or symptoms influenced by neck position.

A meaningful positive result is not simply neck pain. The most relevant finding is reproduction of the client’s familiar arm symptoms, particularly symptoms that follow a radicular or nerve-related pattern. Local neck pain alone should be interpreted more cautiously because it may reflect facet joint sensitivity, muscle guarding, general compression sensitivity or non-radicular neck pain.

Spurling’s Test is most useful when combined with other findings. Evidence supports stronger reasoning when Spurling’s Test is interpreted with cervical distraction, upper-limb tension testing, cervical rotation range and neurological screening.

Quick Summary

Test name: Spurling’s Test
Also known as: Spurling Test, Foraminal Compression Test, Cervical Compression Test
Body region: Cervical spine, nerve roots and upper limb
Purpose: Assess whether cervical compression reproduces familiar arm symptoms
Commonly associated with: Cervical radicular symptom assessment
Positive finding: Reproduction of familiar radiating arm pain, paraesthesia or neurological-type symptoms
Negative finding: No familiar arm symptom reproduction during the test
Best used with: Cervical Distraction Test, Bakody Sign, Upper Limb Tension Test, neurological screen and cervical ROM
Key limitation: Spurling’s Test does not confirm or exclude cervical radiculopathy on its own.

What Is Spurling’s Test?

Spurling’s Test is a cervical compression provocation test. The client’s neck is positioned into extension, lateral flexion and/or rotation toward the symptomatic side, then a gentle axial compression force may be applied. The goal is to observe whether this position reproduces familiar arm symptoms.

Several variations exist. Some protocols use extension and lateral flexion only, while others add rotation and axial compression. Because variations can influence results, the exact version used should be recorded.

Why It Is Used

Spurling’s Test is used to assess whether cervical loading reproduces symptoms consistent with cervical radicular involvement. It may be relevant when a client reports neck pain with arm pain, paraesthesia, numbness, weakness, radiating symptoms or symptoms that change with cervical posture.

The test can support assessment reasoning when a positive response matches the client’s history and neurological findings. It may also help determine whether cervical distraction, Bakody Sign, upper-limb neurodynamic testing and neurological screening should be interpreted with greater attention.

What It Assesses

Spurling’s Test assesses:

• Symptom response to cervical compression
• Reproduction of familiar radiating arm symptoms
• Possible foraminal or nerve root symptom behaviour
• Neck position sensitivity
• Side-to-side symptom response
• Upper-limb paraesthesia, numbness or pain response
• Safety and tolerance to cervical compression

It does not directly identify the specific nerve root, confirm imaging findings, or diagnose cervical radiculopathy by itself.

Who It Is Useful For

Spurling’s Test may be useful for adults with neck pain and radiating arm symptoms, paraesthesia, numbness or symptoms that appear influenced by cervical position.

It may also be useful for professionals learning cervical radicular assessment and symptom provocation testing. It should be modified or avoided when cervical compression is not safe, symptoms are highly irritable, or red flags are present.

When to Use This Test

Use Spurling’s Test when:

• The client has neck pain with arm symptoms
• Cervical radicular symptoms are part of the assessment reasoning
• The client can tolerate cervical positioning safely
• You can monitor familiar arm symptom reproduction
• Neurological screening is also being considered
• The result will be interpreted with other tests, not alone

When Not to Use or When to Be Cautious

Use caution or avoid the test when there is acute trauma, suspected fracture, suspected cervical instability, inflammatory instability, severe osteoporosis risk, vertebral artery or vascular concern, dizziness, unexplained severe headache, worsening neurological signs, myelopathic signs, recent cervical surgery, high symptom irritability or symptoms requiring urgent medical review.

Stop the test if arm symptoms worsen sharply, neurological symptoms increase, dizziness occurs, severe pain develops, the client feels unsafe, or unfamiliar symptoms appear.

Equipment Required

Spurling’s Test requires minimal equipment:

• Chair or treatment table
• Pain and symptom rating scale
• Symptom-location recording method
• Measurz app for structured documentation
• Optional video for setup and posture review
• Optional MAT notes for cervical, neurological and upper-limb findings

Within Measurz, Spurling’s Test can be recorded alongside Cervical Distraction Test, Bakody Sign, cervical ROM, neurological screening, grip strength, upper-limb neurodynamic testing and related symptom maps. Measurz helps document symptom reproduction, test variation, side tested, safety response and comparison over time.

Step-by-Step Protocol / Practice

Setup

Explain that the test places the neck in a position that may reproduce symptoms. Clarify baseline symptoms before testing, including neck pain, arm pain, paraesthesia, numbness, heaviness or radiating symptoms.

Client position

The client sits upright. The shoulders remain relaxed and the client should be able to communicate clearly throughout the test.

Examiner/professional position

Stand behind or beside the client. Position yourself so the head and neck can be supported and controlled.

Hand placement

Place both hands on the client’s head or upper cervical region in a comfortable and controlled position. Avoid sudden force.

Stabilisation

The client should remain relaxed. Avoid excessive cervical movement or compression.

Movement or force direction

A common sequence is:

1. Position the cervical spine into extension.
2. Add lateral flexion toward the symptomatic side.
3. Add rotation toward the symptomatic side if using that variation.
4. Apply gentle axial compression only if safe and necessary.
5. Monitor symptom response.
6. Return to neutral immediately if familiar symptoms are reproduced or symptoms become concerning.

Some clinicians perform the test in stages, stopping when symptoms are reproduced before adding compression.

Instructions

Ask:

“Tell me immediately if this reproduces your familiar arm symptoms.”
“Tell me where you feel the symptom.”
“Is this neck pain only, or does it travel into the arm?”
“Let me know if you feel tingling, numbness, weakness, dizziness or anything unusual.”

Positive finding

A positive Spurling’s Test is reproduction of familiar radiating arm pain, paraesthesia, numbness or neurological-type symptoms. Local neck pain alone should be recorded but interpreted cautiously.

Negative finding

A negative finding is no reproduction of familiar arm symptoms during the test.

Stopping criteria

Stop if familiar arm symptoms are reproduced, symptoms worsen sharply, neurological symptoms increase, dizziness occurs, severe pain develops, or the client asks to stop.

Safety notes

Use gentle compression only. Do not perform the test aggressively. Avoid testing when instability, vascular symptoms or serious pathology concerns are present.

Positive and Negative Test Interpretation

A positive Spurling’s Test may increase suspicion of cervical radicular symptom involvement when it reproduces familiar radiating arm symptoms. It is more meaningful when supported by neurological findings, reduced cervical rotation, positive upper-limb tension testing or symptom relief with cervical distraction.

A positive result does not confirm cervical radiculopathy, nerve root compression, foraminal stenosis or disc pathology. Symptoms may also be influenced by local neck pain, facet sensitivity, muscular guarding, peripheral nerve sensitivity, thoracic outlet symptoms or general pain sensitivity.

A negative Spurling’s Test means the test did not reproduce familiar arm symptoms. This does not exclude cervical radicular involvement, especially when symptoms are intermittent, not present at baseline, provoked by different positions, or primarily detected by neurological or neurodynamic testing.

Sensitivity, Specificity and Diagnostic Accuracy

Spurling’s Test is generally considered more useful when positive than when negative. Many studies report higher specificity than sensitivity, meaning a positive test can help increase suspicion of cervical radicular involvement, while a negative result does not reliably exclude it.

Wainner et al. reported Spurling’s Test sensitivity of approximately 0.50 and specificity of approximately 0.86 in a cervical radiculopathy clinical examination study. The test was most useful when combined with other findings: positive upper-limb tension test A, positive cervical distraction, cervical rotation less than 60 degrees toward the involved side, and positive Spurling’s Test. When all four findings were present, the likelihood of cervical radiculopathy increased substantially.

Rubinstein et al.’s systematic review found that Spurling’s Test generally demonstrated low-to-moderate sensitivity and high specificity across included studies, although study quality and reference standards varied.

More recent work continues to support careful interpretation because diagnostic accuracy depends on population, test variation and reference standard. Spurling’s Test should therefore be interpreted as part of a cluster, not as a stand-alone diagnostic test.

Reliability and Validity

Reliability depends on standardised positioning, force, symptom criteria and test variation. Different versions of Spurling’s Test may produce different results, so the protocol should be recorded clearly.

Validity is stronger when the test reproduces familiar arm symptoms rather than local neck pain alone. It is also stronger when the result aligns with neurological examination, cervical distraction response, upper-limb neurodynamic testing and cervical rotation limitation.

Validity is weaker when symptoms are vague, non-familiar, localised only to the neck, or when the test is performed with excessive force.

Common Errors and Limitations

Common errors include:

• Treating local neck pain alone as a clear positive radicular sign
• Applying compression too forcefully
• Using the test despite red flags
• Not recording the test variation used
• Failing to ask whether symptoms are familiar
• Not documenting symptom location
• Using the test alone to diagnose cervical radiculopathy
• Ignoring neurological screening
• Continuing after symptoms are reproduced
• Not differentiating cervical radicular symptoms from shoulder or thoracic outlet symptoms

Limitations include variable sensitivity, protocol variation, overlap with other conditions, dependence on symptom criteria and limited rule-out value when negative.

Practical Applications

Spurling’s Test can be useful when a client presents with neck pain and radiating arm symptoms. It may help identify whether cervical compression reproduces familiar symptoms and whether cervical radicular assessment should be explored further.

In practice, the test is most valuable when recorded precisely. Measurz documentation should include the side tested, neck position, whether compression was applied, symptom location, symptom quality and whether the response was familiar.

How to Record This in Measurz

In Measurz, record:

• Test name: Spurling’s Test
• Side tested
• Test variation used
• Cervical position: extension, lateral flexion, rotation
• Whether axial compression was applied
• Baseline symptoms
• Pain or symptom score before, during and after
• Symptom location
• Symptom quality: pain, tingling, numbness, heaviness or paraesthesia
• Whether symptoms were familiar
• Local neck pain versus arm symptoms
• Result: positive, negative, unclear or unable to test
• Reason for stopping
• Dizziness, nausea or vascular symptoms if present
• Neurological symptoms
• Confidence in result
• Related Cervical Distraction, Bakody, cervical ROM, neurological screen and upper-limb neurodynamic findings
• Referral notes if neurological signs are concerning

Recording these details improves repeatability, communication, symptom tracking, client education, assessment reasoning and reporting quality.

Related Tests / Internal Links

• Cervical Distraction Test
• Bakody Sign
• Upper Limb Tension Test
• Cervical ROM Assessment
• Neurological Screen
• Grip Strength Test
• Cervical Flexion Rotation Test
• Cervical Rotation Lateral Flexion Test
• Adson’s Test
• Roos Stress Test

FAQs

What is Spurling’s Test used for?

Spurling’s Test is used to assess whether cervical compression reproduces familiar radiating arm symptoms associated with cervical radicular presentations.

What is a positive Spurling’s Test?

A positive finding is reproduction of familiar arm pain, paraesthesia, numbness or radiating neurological-type symptoms.

Does Spurling’s Test diagnose cervical radiculopathy?

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

What is a negative Spurling’s Test?

A negative result means the test did not reproduce familiar arm symptoms. It does not fully exclude cervical radicular involvement.

Is neck pain alone a positive test?

Local neck pain should be recorded, but it is less specific for cervical radicular involvement than familiar arm symptom reproduction.

Should compression always be added?

No. The test can be performed in stages, and compression should be gentle and only used when safe and necessary.

What should be recorded in Measurz?

Record side, neck position, compression use, symptom location, familiar symptom reproduction, test variation, stopping reason and related findings.

Key Takeaways

Spurling’s Test is a cervical radicular symptom provocation test.
A positive result is most meaningful when familiar arm symptoms are reproduced.
The test is generally more useful for increasing suspicion when positive than excluding radiculopathy when negative.
It should be interpreted with cervical distraction, ULTT-A, cervical ROM and neurological screening.
Measurz should capture test variation, symptoms, side tested, safety response and related findings.

References

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

Sleijser-Koehorst, M. L. S., Coppieters, M. W., Epping, R., Rooker, S., Verhagen, A. P., & Scholten-Peeters, G. G. M. (2021). Diagnostic accuracy of patient interview items and clinical tests for cervical radiculopathy. Physiotherapy, 111, 74–82. https://doi.org/10.1016/j.physio.2020.07.007

Tong, H. C., Haig, A. J., Yamakawa, K. S. J., Miner, J. A., & Parres, C. M. (2002). Specificity of needle electromyography for lumbar radiculopathy and plexopathy in 55–79-year-old asymptomatic subjects. American Journal of Physical Medicine & Rehabilitation, 81(8), 598–607.

Wainner, R. S., Fritz, J. M., Irrgang, J. J., Boninger, M. L., Delitto, A., & Allison, S. (2003). Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy. Spine, 28(1), 52–62. https://doi.org/10.1097/00007632-200301010-00014

Yousif, M. S., Occhipinti, G., Bianchini, F., Feller, D., Schmid, A. B., & Mourad, F. (2025). Neurological examination for cervical radiculopathy: A scoping review. BMC Musculoskeletal Disorders, 26, 334. https://doi.org/10.1186/s12891-025-08560-9