Spurling maneuver to detect cervical radiculopathy

The Spurling maneuver is used to detect cervical radiculopathy. Several positions of the head may be tested to provoke nerve irritation. First, the maneuver is performed with the head held in a neutral position (not shown). The examiner taps or presses down on the top of the head. If this fails to reproduce the patient's pain, the procedure is repeated with the head rotated and tilted to the affected side and hyperextended as shown in the photograph. Reproduction of symptoms beyond the shoulder is considered positive, whereas reproduction of neck pain alone is nonspecific. The Spurling maneuver should be performed with caution in patients with suspected rheumatoid arthritis, cervical malformations, or metastatic disease since it may cause further injury to the spine.