21/02/2026
𝗪𝗵𝗮𝘁 𝗶𝘀 𝘁𝗵𝗲 𝗱𝗶𝗮𝗴𝗻𝗼𝘀𝘁𝗶𝗰 𝗮𝗰𝗰𝘂𝗿𝗮𝗰𝘆 𝗼𝗳 𝗽𝗵𝘆𝘀𝗶𝗰𝗮𝗹 𝘁𝗲𝘀𝘁𝘀 𝘂𝘀𝗲𝗱 𝘁𝗼 𝗮𝘀𝘀𝗲𝘀𝘀 𝗳𝗼𝗿 𝘁𝗵𝗲 𝗽𝗿𝗲𝘀𝗲𝗻𝗰𝗲 𝗼𝗳 𝗖𝗲𝗿𝘃𝗶𝗰𝗮𝗹 𝗥𝗮𝗱𝗶𝗰𝘂𝗹𝗼𝗽𝗮𝘁𝗵𝘆?
Cervical radiculopathy (CR) is a clinical condition characterised by motor, reflex and/or sensory changes such as paraesthesia or numbness, often provoked by neck posture(s) and/or movement(s) (https://pubmed.ncbi.nlm.nih.gov/19087147/). CR is usually caused by compression of the nerve root due to cervical disc herniation or degenerative spondylotic changes, but radicular symptoms can also occur without evident compression, for instance, due to inflammation of the nerve (https://pubmed.ncbi.nlm.nih.gov/19762151/).
A population-based study US study found an annual incidence rate of 107.3 per 100,000 for men and 63.5 per 100,000 for women (https://pubmed.ncbi.nlm.nih.gov/19087147/).
Although there is no diagnostic “gold standard", a combination of history taking, physical examination, including neurological assessment and Magnetic Resonance Imaging (MRI) is generally considered best evidence-based clinical practice in primary and secondary health care (https://pubmed.ncbi.nlm.nih.gov/29228289/, https://pubmed.ncbi.nlm.nih.gov/21168100/, https://pubmed.ncbi.nlm.nih.gov/19087147/).
📘 In a brand-new publication Thoomes and colleagues (https://pubmed.ncbi.nlm.nih.gov/41680685/) conducted an update of their former review (https://pubmed.ncbi.nlm.nih.gov/28838857/) to answer the following question: “What is the diagnostic accuracy of physical tests used to assess for the presence of CR?
📊 𝗥𝗲𝘀𝘂𝗹𝘁𝘀
In total, eight studies were included. Diagnostic value was assessed for six physical examination tests.
📋 𝗦𝗽𝘂𝗿𝗹𝗶𝗻𝗴’𝘀 𝘁𝗲𝘀𝘁 (picture 1): Across five studies, specificity was consistently high (0.84–1.00), while sensitivity varied widely (0.38–0.98). Likelihood ratios were reported as very low certainty and varied considerably across study versions of the test, limiting any single pooled LR estimate.
▶️ 𝗖𝗹𝗶𝗻𝗶𝗰𝗮𝗹 𝗺𝗲𝗮𝗻𝗶𝗻𝗴: a clearly positive Spurling’s can support ruling in CR when history/neurology already point that way, but the exact post-test shift depends on how the test is performed and the population studied.
📋 𝗨𝗟𝗡𝗧1: (median nerve bias): pooled LR+ 2.45 (95% CI 1.79–3.36) and LR– 0.42 (95% CI 0.30–0.59)
𝗖𝗹𝗶𝗻𝗶𝗰𝗮𝗹 𝗺𝗲𝗮𝗻𝗶𝗻𝗴: modest value for both ruling in (small-to-moderate increase) and ruling out (moderate decrease), best used as part of a test cluster.
📋 𝗖𝗼𝗺𝗯𝗶𝗻𝗲𝗱 𝗳𝗼𝘂𝗿 𝗨𝗟𝗡𝗧𝘀 (median (ULNT1 and ULNT2a), radial (ULNT2b) and ulnar (ULNT3) criterion: at least one positive): pooled LR+ 1.99 (95% CI 1.57–2.52) and LR– 0.06 (95% CI 0.02–0.25)
▶️ 𝗖𝗹𝗶𝗻𝗶𝗰𝗮𝗹 𝗺𝗲𝗮𝗻𝗶𝗻𝗴: the strength here is the rule-out performance—a negative cluster result makes CR unlikely in the studied secondary-care populations. Reproduction of a familiar symptomatic complaint and structural differentiation should both be met as a positive test criteria (https://pubmed.ncbi.nlm.nih.gov/34298491/).
📋 𝗦𝗵𝗼𝘂𝗹𝗱𝗲𝗿 𝗮𝗯𝗱𝘂𝗰𝘁𝗶𝗼𝗻 𝗿𝗲𝗹𝗶𝗲𝗳 𝘁𝗲𝘀𝘁: pooled LR+ 2.08 (95% CI 1.32–3.27) and LR– 0.66 (95% CI 0.52–0.85)
▶️ 𝗖𝗹𝗶𝗻𝗶𝗰𝗮𝗹 𝗺𝗲𝗮𝗻𝗶𝗻𝗴: limited rule-out value; a positive test provides only a small-to-moderate increase in probability.
▶️ 𝗖𝗼𝗻𝘀𝗲𝗾𝘂𝗲𝗻𝗰𝗲𝘀 𝗳𝗼𝗿 𝗰𝗹𝗶𝗻𝗶𝗰𝗮𝗹 𝗽𝗿𝗮𝗰𝘁𝗶𝗰𝗲
✅ Use ULNT clusters primarily to rule out CR. With LR– ~0.06, a negative combined ULNT cluster can meaningfully reduce post-test probability and may help avoid premature imaging or referral when the overall picture is otherwise reassuring
✅ Use Spurling’s as a rule-in adjunct, not a standalone decision-maker. Its high specificity supports CR when positive, but heterogeneity in ex*****on and very low-certainty LRs mean it should be interpreted in context (https://pmc.ncbi.nlm.nih.gov/articles/PMC7889177/)
✅ Anchor decisions in history + neurological exam. The review reinforces that physical tests shift probability; they do not replace a coherent clinical hypothesis. Evidence is also largely from secondary care, so calibration may differ in primary care
❎ However, evidence on the diagnostic accuracy of all physical tests for the diagnosis of CR is sparse, and the certainty of the evidence was very low for all outcomes of all tests, implying that new studies of high methodological value are still required to strengthen these results. Because of the small number of studies, the pooled estimates are valid only for the populations and tests studied in the specific studies included in this review.
