Dr. Ebraheim's animated educational video describing the Spurling's Test cervical spine radiculopathy.
The Spurling's Test is a physical exam provocative test. The Spurling's Test is used frequently to asses cervical nerve root impingement or irritation. The Spurling's Test is specific for evaluation of the cervical nerve roots.
The patient will come to the doctor with the complaint of neck pain. If the pain is due to nerve root irritation with eh pain radiating to the ipsilateral upper extremity, the doctor will try to see if the patient has a cervical disc herniation with irritation of the nerve root.
Keep in mind that cervical spine problems and shoulder problems overlap. The doctor will exam the patient carefully. Each nerve that is involved will show its effect on the motor power, the sensation and reflexes.
Motor C7: elbow extension, wrist flexion, finger extension.
Reflexes C7: triceps reflex
Herniated C6C7 bulge
Each level will get the nerve to the lower number. Herniation at the level of C5C6 will get the C6 nerve root.
Sensory C6
C6 wrist extension (extensor carpi radials longus and brevis
Biceps C5, C6
Reflexes C6: brachioradialis reflex
Herniated C6C7 bulge
Sensory C7
Motor: triceps C7, wrist flexion, finger extension.
Reflexes: C7 triceps reflex
There are some other tests for cervical spine radiculopathy which are called provocative test.
The Spurling's Test is performed to assess cervical nerve root pain and impingement. The clinician will be standing behind the patient. the patient can be sitting down or standing up. there should be extension, lateral flexion and some rotation of the neck towards the affected side. Downward compressive force to the top of the patient’s head is applied (Axial loading). A positive test will reproduce the pain in the upper extremity when the compressive force is applied. A positive test causes radiating pain down the patient’s arm. Radiating pain will be attributed to the nerve root impingement or compression on the same side (ipsilateral side).
Shoulder abduction test
The shoulder abduction test is different. The patient’s symptoms are relived by shoulder abduction, by placing the hand over the head. This test helps to differentiate between cervical spine pathology and other causes of shoulder pain. It is an important test for cervical radicular compressive diseases. The relief of the symptoms occurs due to decreased tension on the nerve roots. If there is a relief of symptoms by shoulder abduction, then the cause of shoulder pain is not a shoulder pathology, but it is pain that is probably coming from cervical nerve root pathology due to nerve irritation. These patients with cervical nerve root irritation could be treated conservatively up to 3 months with therapy, nonsteroidal antiinflammatory drugs (NSAIDs) and 75% of these patients will improve with nonoperative treatment.
When should you do surgery?
If the patient has persistent pain for 612 weeks
If there is progressive neurological deficit.

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