Which provocative tests are used in the evaluation of cervical radiculopathy?

Updated: Oct 08, 2018
  • Author: Gerard A Malanga, MD; Chief Editor: Sherwin SW Ho, MD  more...
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Answer

Provocative tests

  • The foraminal compression test, or Spurling test, is probably the best test for confirming the diagnosis of cervical radiculopathy. It is performed by positioning the patient with the neck extended and the head rotated, and then applying downward pressure on the head. The test is considered positive if pain radiates into the limb ipsilateral to the side to which the head is rotated. The Spurling test has been found to be very specific (93%), but not sensitive (30%), in diagnosing acute radiculopathy. [11] Therefore, it is not useful as a screening test, but it is clinically useful in helping to confirm cervical radiculopathy. [14]

  • Manual cervical distraction can be used as a physical examination test. With the patient in a supine position, gentle manual distraction often greatly reduces the neck and limb symptoms in patients with radiculopathy.

  • Lhermitte sign is an electric shock-like sensation radiating down the spine, and in some patients into the extremities, elicited by flexion of the neck. This sign has been found in patients with cervical cord involvement or cervical spondylosis, and also in patients with tumor and multiple sclerosis (MS); however, the Lhermitte sign should be negative in those with cervical radiculopathy. Manual distraction may reduce the neck and limb symptoms in patients with cervical radiculopathy.


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