Provocative Diagnostic Testing for Cervical Radiculopathy

Original Article: Cervical Radiculopathy: Nonoperative Management of Neck Pain and Radicular Symptoms Issue Date: January 1, 2010 Available at: https://www.aafp.org/afp/2010/0101/p33.html to the editor: I read with interest Dr. Eubanks' article on nonoperative management of cervical radiculopathy. Because of the discomfort and expense associated with electrophysiologic and diagnostic imaging studies, it is desirable to have an accurate means to identify patients who need further evaluation. A systematic review of six studies showed that in patients without neurologic deficits, positive results on the Spurling test, neck distraction test, and Valsalva test (each with low-moderate sensitivity and high specificity) are most useful for ruling in cervical radiculopathy, whereas a negative upper limb tension test result (high sensitivity and low specificity) is most useful for ruling it out.1 In a blinded prospective study, positive results on the Spurling test, neck distraction test, and upper limb tension test coupled with a less than 60 degree cervical rotation toward the symptomatic side was associated with a positive likelihood ratio of 30.3 for detection of cervical radiculopathy compared with the reference standard of electromyography.2 In the classic Spurling test, the neck is passively hyperextended and laterally flexed toward the symptomatic side. The examiner places the patient's upper extremity into: (1) scapular depression; (2) shoulder abduction; (3) forearm supination with wrist and finger extension; (4) shoulder external rotation; (5) elbow extension; and (6) contralateral then ipsilateral cervical lateral flexion.