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Special tests for Cervical Radiculopathy

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What does Cervical Radiculopathy mean?

Cervical radiculopathy is a medical condition that arises from the irritation or damage of one or more nerve roots located in the neck region, which can lead to symptoms like pain, weakness, numbness, or 
tingling sensations in the arms, shoulders, and neck. 

The underlying cause of cervical radiculopathy is often linked to spinal conditions like herniated discs, spinal stenosis, or degenerative disc disease, which compress or put pressure on the nerves in the cervical spine. Treatment options for cervical radiculopathy may include medication, physical therapy, or surgery in severe cases.

Spurling test:

Purpose:

The Spurling test is a physical examination used to diagnose cervical radiculopathy, which results from the compression or irritation of cervical nerve roots. This test is named after Dr Harry Spurling, who 
first described it in 1944.

Technique:

During the Spurling test, the patient sits with their head tilted and rotated to one side. The examiner applies downward pressure on the top of the patient's head while they extend their neck. If the patient 
experiences symptoms such as pain, numbness, tingling, or weakness in the arm or hand on the same side as the head rotation, it may indicate cervical radiculopathy.

Specificity: 90% 
Sensitivity: 30-60%

Shoulder abduction test:


also known as the Bakody test

Technique:

The shoulder abduction test is performed by asking the patient to raise their arm above their head to a comfortable position. The examiner then applies a downward force to the patient's arm to add some resistance, and the patient is instructed to lower their arm slowly to the side. A positive test result is indicated if this movement causes or exacerbates the patient's symptoms, which may suggest the presence of nerve root compression in the cervical spine. 

Specificity: 22%-100%
Sensitivity: 40%-92%

ULTT (Upper limb tension test):


It is performed to assess the sensitivity or tension of the nerves that run from the neck to the hand, including the brachial plexus and median, radial, and ulnar nerves. The test can also help identify the location of nerve compression or entrapment and differentiate between cervical radiculopathy and peripheral nerve entrapment syndromes.

Depending on the nerve or nerve root being tested, the ULTT is carried out with the patient supine and the involved arm positioned in a particular way. A series of motions are used in the test to gradually tighten the nerves and nearby tissues.


Specificity: 63%-83%
Sensitivity: 60%-81%

Lhermitte's test:


The patient is sitting or lying down in a comfortable position for the Lhermitte test. The patient may experience an electric shock or buzzing that travels down the spine and into the limbs if the examiner flexes the patient's neck forward at this point. If the patient describes the expected symptoms, the test is deemed positive.

The test's sensitivity and specificity vary depending on the population tested and the underlying condition.

Modified Spurling test:


The examiner performs the modified Spurling test with the patient either sitting or lying down. The examiner first passively extends the patient's neck and then laterally flexes it to the affected side while applying downward pressure to the head. This maneuver compresses the intervertebral foramen, which can potentially compress the affected nerve root and may reproduce or worsen the patient's symptoms. A positive test result is indicated by the presence of symptoms on the affected side, such 
as pain, numbness, or tingling.

Specificity: 75%-95%
Sensitivity: variable 








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