Clinical Update: 3 Accurate Tests for Diagnosing Cervical Radiculopathy

By Dr. David I. Graber 

There are three accurate methods of in-office physical testing to diagnose cervical radiculopathy: The cluster of four tests in the Cervical Radiculopathy Clinical Prediction Rule (CRCPR), the Neck Tornado Test, and the Arm Squeeze Test.

CRCPR – The following four tests are used:

1. Cervical Rotation AROM – less than 60 degrees to the affected side is considered positive.
2.Spurling A Test – seated maximal foraminal compression in lateral bending to the symptomatic side is positive if it produces or aggravates the upper extremity symptoms.
3.Supine Cervical Spine Distraction Test – a positive test is if it relieves the upper extremity symptoms.
4.Upper Limb Tension Test A – the patient is in a supine position. The doctor places the patient’s upper extremity in he following sequence: (1) scapular depression; (2) shoulder abduction; (3) forearm supination with wrist and finger extension; (4) shoulder external rotation; (5) elbow extension; and (6) contralateral then ipsilateral cervical lateral flexion. The test is positive for cervical radiculopathy with provocation of UE symptoms with contralateral cervical side bending, or with a decrease in symptoms with ipsilateral side bending.

These were found by Wainner to be predictive of cervical radiculopathy (CR) when compared with EMG findings. The post test probability of CR: If 3 positive tests = 65%; If 4 positive tests = 90%. 4 positive tests also had a 99% specificity (i.e. if positive it rules the diagnosis in), but low sensitivity (i.e. if the tests are negative it may be a false negative diagnosis).(1)

Neck Tornado Test (NTT): The patient is seated. The patient’s neck is fully flexed and downward axial pressure is put through the head. Maintaining the pressure the doctor rotates the neck toward the direction of the pain site, progressing to full lateral bending and full extension of 180°, in a tornado pattern. The test is positive if it reproduced or aggravated radicular pain in the upper extremity.
The NTT yields high sensitivity of 85%, meaning that if the NTT is negative, then the patient most likely doesn’t have CR.(2)

International Journal of Medical Sciences 14: 0662 image No. 004

Arm Squeeze Test:  This test is used to distinguish cervical nerve root compression radicular pain from referred pain coming from shoulder. The test couldn’t be simpler. Just squeeze the middle third of the patient’s upper arm with your thumb on the patient’s triceps, while the rest of the fingers are on the patient’s biceps. Use about 10-15 pounds of pressure. Then squeeze the acromioclavicular and anterolateral-subacromial shoulder area. Compare the pain levels. If the pain is rated as 3 points greater on the VAS with the arm squeeze, then it’s highly likely it’s from the cervical spine.  The Gumina study found Arm Squeeze test had both very high sensitivity (97%) and specificity (>91%) in differentiating cervical spine from shoulder origins of arm pain.(3) 

(1) Wainner, R., Fritz, J., Irrgang, J., Boninger, M., Delitto, A., & Allison, S. (2003). Reliability and Diagnostic Accuracy of the Clinical Examination and Patient Self-Report Measures for Cervical Radiculopathy. Spine, 28, 52-62.
(2) Park J, Park WY, Hong S, An J, Koh JC, Lee YW, Kim YC, Choi JB. Diagnostic Accuracy of the Neck Tornado Test as a New Screening Test in Cervical Radiculopathy. Int J Med Sci 2017; 14(7):662-667. doi:10.7150/ijms.19110.
(3) Gumina S, Carbone S, Albino P et al. Arm squeeze test: a new clinical test to distinguish neck from shoulder pain. European Spine Journal 2013; 22: 1558-63.

Originally published in the ANJC Back Channel, March 17, 2021

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