Imagine, you are working in the office looking at the computer. Suddenly, you feel a strange sensation like a current running down your arm along with a slight pain in your neck. After a while, your fingers start to feel a little numb. This may last for a day or two, and then it will reappear one day. You may think, "Oh, maybe it's because I changed the pillow" or "Maybe it's because I'm working too hard." But if these symptoms persist, it's not a good idea to just ignore them as normal. This could be due to a pinched nerve in your cervical spine. So, today we are going to talk about a very simple, but very important physical examination that your doctor will perform to find out the exact cause of this.
What exactly is the Spurling Test?
Simply put, the Spurling test is a physical test that your doctor performs using only his or her hands to check for a pinched nerve in your neck. It doesn't require a big machine, and you don't get any injections. It's done in the same room as your exam.
Medically, we call this collection of symptoms caused by a pinched nerve in the neck 'Cervical Radiculopathy' . Although the name is a bit complicated, the meaning is simple. It means that a nerve root that comes out of the spinal cord in the neck area is being compressed.
Our cervical spine is not just a bunch of bones stacked on top of each other. From these seven cervical vertebrae, important nerves emerge that carry messages from our brain to our arms, shoulders, and upper body that control sensation and movement. The small holes through which these nerves emerge are called foramen. Sometimes, with age, due to poor posture (especially when using computers and phones), or due to a minor accident, a disc in the vertebrae can bulge out, or small bone spurs can form, which can compress the nerve root. This is when the nerve root becomes compressed.
So, what the `Spurling test` does is, the doctor very carefully moves your neck into a certain position, narrows the opening where the nerve comes out a little bit more. Then, the already slightly compressed nerve is compressed a little bit more and you feel symptoms like pain and numbness. That way, the doctor can get a good idea of whether this is the cause of your problem.
What time is this test done?
If you have been experiencing neck pain for about a month along with one or more of the symptoms below, your doctor may want to perform this test. Let's see what these symptoms are exactly.
| Symptom | How does that make you feel? |
|---|---|
| Pain | This is not just a typical neck pain. It is a radiating pain that starts in the neck, spreads through the shoulder, and down the arm to the fingers. For some, it can feel like a sharp, stabbing pain , while for others, it can feel like a burning sensation . |
| Numbness or Tingling | You may feel a tingling sensation in your hands and fingers, or a tingling sensation. Sometimes, parts of your hand may feel like they don't belong to you, like you have no sensation at all. This can make it difficult to hold something like a cup properly. |
| Weakness | You may feel a lack of strength in your hand muscles. For example, you may feel weak when lifting a heavy object, opening a door, or even when writing. |
Do you need to prepare for this test in advance?
No way! There's no need to prepare for this. You don't need to fast the day before or take any special medicine. It's very simple.
But, if you take care of the little things, it will be easier for both you and the doctor.
- Clothing: It's best to wear loose clothing that leaves the neck area free, without a large collar. For example, a turtleneck sweater, or a saree that is worn with the bottom down.
- Jewelry: Do not wear heavy necklaces or earrings. They may interfere with the test.
- Headscarf: If you wear a headscarf, you don't need to remove it. The doctor will conduct the examination accordingly.
Before performing this `Spurling test`, the doctor will perform a general physical examination of you and ask about your medical conditions, medications you are taking, and previous accidents. So be prepared to explain your medical history clearly.
Are there any cases where this test should not be done?
Yes, definitely. This is a very important issue.
This test is not done for every neck pain. If you have certain other medical conditions, the doctor will likely refer you directly for another test, such as a `CT scan` or `MRI`, as this test may be harmful.
Here are some of the main reasons why this test is not performed:
- If there is cervical spine instability.
- If there is pressure or damage to the spinal cord in the neck (Cervical spondylotic myelopathy) .
- If you have recently had a serious injury to your back or neck.
- If you have severe joint diseases like rheumatoid arthritis .
- If there is a suspicion that cancer from elsewhere in the body has spread (metastasized) to the neck bones.
Your doctor will consider all of this and decide whether to perform the test or not. So there's nothing to be afraid of.
What actually happens when you take the test?
This will only take a few minutes. There is no reason for you to be afraid or anxious. The doctor will explain everything he is doing to you.
Step 1: Adjusting the posture
First, the doctor will ask you to sit or stand upright in a chair. Keep your back straight and relax.
Step 2: Lateral Flexion of the Neck
Next, the doctor will very gently place his hands on the top of your head and gently bend your neck toward the side where the pain is. As if bringing your ear to your shoulder. He will ask if you feel any pain at this time.
Step 3: Neck Rotation and Extension
Then, while keeping the neck bent to that side, turn it back a little and look. All these movements are done very carefully and carefully.
Step 4: Gentle thrust (Axial Compression)
Finally, with your neck in that specific position, the doctor will apply a very small, gentle downward push (light pressure) from the top of your head.
The most important thing is that if you feel anything while doing these steps, like pain or numbness that you had before, you should tell the doctor right away. He or she will probably tell you to raise your arm if you feel any pain. If you feel any discomfort, he or she will stop the test right away. You will not be doing anything that will make the pain worse.
How do the results come out and what do they mean?
The results of this test are available immediately. The doctor will tell you the details as soon as the test is completed. There are two types of results: 'Positive' or 'Negative'.
| Result | What does that mean? |
|---|---|
| Positive | You said you felt pain or the symptoms mentioned earlier (pain radiating down the arm, numbness). This means that your symptoms are most likely caused by a pinched nerve in your neck. Your doctor will likely order a CT scan or MRI to confirm this and see exactly where the pinched nerve is and what is causing it. |
| Negative | You didn't feel any pain or any special symptoms during the examination. That means it's unlikely that you have a pinched nerve in your neck. However, it's not 100% certain that there's no problem. There could be another cause for your pain (e.g., a muscle problem). Your doctor may want to do more tests to find out. |
What do you do next if the test is positive?
We shouldn't be afraid of the test being 'positive'. It's actually a good thing. Because it means we've pretty much found the cause of our problem. The next step is treatment.
Once the doctor has confirmed the diagnosis with an MRI scan, the appropriate treatment will begin. There are several treatment options:
- Medications: Giving medications to reduce pain and swelling of the nerve.
- Rest and Activity Modification: Advise to temporarily stop activities that put pressure on the neck (lifting heavy loads, staring down for long periods of time).
- Physical Therapy: This is very important. Here, you will be taught many things, such as exercises to strengthen the neck muscles, how to correct neck posture, and how to avoid putting pressure on the neck during daily activities.
- Surgery: This is not necessary in most cases. If the above treatments do not help, and if the nerve compression is very severe, your doctor may recommend surgery.
When should I see a doctor?
If you've had neck pain for several weeks, if it's getting worse, or if it's not getting better, you should definitely see a doctor. Don't ignore it, especially if you feel pain, numbness, or weakness in your arm.
The Spurling test is a simple, inexpensive test that helps your doctor get a better idea of your symptoms. It can be a little scary because it's a pain test. But if your doctor feels any discomfort, they'll stop the test right away. So there's nothing to worry about.
Take-Home Message
- The `Spurling test` is a simple physical test performed by a doctor to check for a pinched nerve in the neck.
- This test may be performed if you have symptoms such as pain radiating from your neck to your arm, numbness, or weakness in your arm.
- This does not require any special preparation, and the test only takes a few minutes.
- It is very important to tell the doctor immediately if you feel any discomfort during the examination.
- If the result is 'positive', it means that the cause of the disease has been found. After that, you can proceed to permanent treatment.
- If neck pain and related symptoms persist, don't ignore it and definitely see your doctor.
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