Value of provocative tests for diagnosing cervical radiculopathy

What is the value of provocative tests for diagnosing cervical radiculopathy due to nerve root compression within the foramina of the cervical vertebrae?

Provocative maneuvers vary in their sensitivity and specificity for diagnosing cervical radiculopathy. The values listed below are for acute cervical radiculopathy. The sensitivity for each of the tests is approximately 30% lower for chronic cervical radiculopathy.

• Spurling’s maneuver: with the patient seated, downward pressure is uniformly applied to the patient’s cranium while the head is gently rotated or flexed toward the side of the suspected lesion. The immediate development of pain and/or paresthesias with radiation to the upper limb (see below) is indicative of cervical radiculopathy; sensitivity 45% to 55% and specificity 85% to 93%.

• Shoulder abduction test: with the patient seated, the palm of the affected extremity is actively placed on top of the head. The test is considered positive if this position relieves the radicular pain; sensitivity 45% to 55% and specificity 85%.

• Upper limb tension test: with the patient lying in supine position with affected arm placed on their body. The arm is abducted by the examiner with the forearm pronated and flexed. The forearm is then extended and supinated. Finally the hand is extended from the wrist. Reproduction of symptoms is positive; sensitivity 60% to 80% and specificity 20% to 40%.

• Traction/neck distraction test: with patient sitting, gently lift the head cephalad (apply traction). Test considered positive if radicular pain is improved; sensitivity 44% and specificity 95%.

• Valsalva maneuver: with patient seated, have them take a deep breath and try to exhale it against a closed glottis for 2 to 3 seconds. Reproduction of radicular symptoms is a positive test; sensitivity 22% and specificity 94%.

15585

Sign up to receive the trending updates and tons of Health Tips

Join SeekhealthZ and never miss the latest health information

15856