ABSTRACT: This week’s abstract is “The value of provocative tests in diagnosis of cervical radiculopathy.”Ghasemi M¹, Golabchi K, Mousavi SA, Asadi B, Rezvani M, Shaygannejad V, Salari M. J Res Med Sci. 2013 Mar;18(Suppl 1):S35-8.

BACKGROUND:

This study was aimed at assessing the accuracy of provocative tests in diagnosis of acute or chronic Cervical Radiculopathy (CR) based on an electrodiagnostic reference criterion.

MATERIALS AND METHODS:

Shoulder Abduction Test (SAT), Spurling Test (ST), Upper Limb Tension Test (ULTT), and electromyography were done on 97 patients who referred to Electrodiagnostic center in the university hospital from January 2010 to March 2011. All of the participants had neck and radicular pain for at least 3 weeks. They were classified according to electrodiagnostic findings. Then diagnostic values of provocative tests were assessed in diagnosis of acute or chronic CR on the basis of reference criterion.

RESULTS:

SAT and ST were more specific (85%) compared to ULTT, while ULTT was more sensitive (60.46% in acute and 35.29% in chronic) than the other two. SAT and ST had a significant accuracy for comparison between acute and chronic CR (P < 0.05).

CONCLUSION:

ULTT is suitable for screening of CR, while SAT and ST can support diagnosis. SAT and ST are good diagnostic tests for comparison between acute and chronic CR.

KEYWORDS:

Cervical radiculopathy; electrodiagnostic study; shoulder abduction test; spurling test; upper limb tension test

 Why Should you Care?

This article validates the use of upper limb tension tests (ULTT’s) with ruling in/out cervical radiculopathy during evaluation. As we all know, one test does not make a diagnosis. The researchers at Gashemi et al. have analyzed three different tests, the Shoulder Abduction Test (also could be referred to as Bakody’s sign), the ULTTs and Spurling’s Test. Here are the conclusions …

• ULTTs are very sensitive (can detect a higher proportion of the population with cervical radiculopathy.
• SAT and Spurling’s Test can be used to differentiate between Acute and Chronic cervical radiculopathy, with positive’s in both suggesting more acute CR and negatives increasing the likelihood of a more chronic condition.

These tests will assist in clinical reasoning/pattern recognition. This article points out there is a lack of a gold standard for testing for cervical radiculopathy and provides a series of tests for consideration using electrodiagnostic testing.

These tests are all incorporated by NAIOMT in the cervical scanning examination and with addition of key muscle (myotomal testing), sensation and reflex testing a clearer picture of the patients diagnosis and prognosis should emerge. Join an upcoming manual therapy course in your region.

Also refer to The correlation between Spurling test and imaging studies in detecting cervical radiculopathy. J Neuroimaging. 2012 Oct;22(4):375-8. doi: 10.1111/j.1552-6569.2011.00644.x. Epub 2011 Sep 1. Shabat S¹, Leitner Y, David R, Folman Y.

–Terry Pratt, MS, PT, COMT, FAAOMPT

Terry is a Faculty and Clinical Fellowship Instructor for NAIOMT and has lab assisted with the Institute since 2002. He’s served as adjunct faculty at several universities, developed teaching manuals for the McConnell Institute faculty, produced technique videos for NAIOMT, formatted and reviewed the textbook ‘Manipulative Thrust Techniques of the Spine’ by Erl Pettman, and the manual for distance mentoring for NAIOMT clinical fellowship instructors and fellows in training. Terry has written a section for a home study course for the Orthopedic Section of the APTA addressing treatment of the injured lumbar spine published in 2015. Learn more.