Validity of Clinical Tests in the Diagnosis of Root Compression in Cervical Disc Disease

Viikari‐Juntura, Eira; Porras, Matti; Laasonen, E. M.

doi:10.1097/00007632-198903000-00003

Cited by 149 publications

(116 citation statements)

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“…In two studies [21,62], it was necessary to recalculate these figures using the raw numbers presented. Diagnostic odds-ratio's (DOR's) were not calculated because of the recent suggestion that a DOR does not meaningfully describe a marker's ability to classify subjects [41].…”

Section: Discussionmentioning

confidence: 99%

“…We excluded 354 studies on the basis of their titles and abstracts. We then retrieved and reviewed 12 full reports for possible inclusion [4,19,21,35,42,48,51,55,59,60,62,63]. Four studies were excluded because they examined either reliability or repeatability of the test, but not diagnostic accuracy [4,19,35,48].…”

Section: Data Synthesismentioning

confidence: 99%

“…Two studies were excluded because the tests were used to evaluate clinical conditions other than radiculopathy [55,60]. This resulted in six studies which fulfilled our inclusion criteria [21,42,51,59,62,63], all of which were found in MEDLINE. Subsequently, we searched PubMed and CINAHL for additional relevant articles, which resulted in 218 and 66 additional references, respectively, not found in the Embase.com search.…”

Section: Data Synthesismentioning

confidence: 99%

“…Multiple studies evaluated the following provocative tests: ULTT [42,63], Spurling's test [51,59,62,63], shoulder abduction test [21,62,63], traction/neck distraction [63,62], while only a single study was found for the Valsalva's manoeuvre [63]. No studies were identified which examined the axial compression test or shoulder depression test.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…To that end, various clinical provocative tests have been proposed which purport to be diagnostic of cervical radiculopathy [4,42,46,59,62,63]. Examples of these tests include, but are not limited to the upper limb tension test [ULTT] (formerly called the brachial plexus tension test, or test of Elvey) [3,24,32,42,44,49,63], the shoulder abduction test (also known as the shoulder abduction relief sign) [21,25], and Spurling's test (also known as the foraminal compression test, neck compression test, or quadrant test) [36,54,59,60].…”

Section: Introductionmentioning

confidence: 99%

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A systematic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy

et al. 2006

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Clinical provocative tests of the neck, which position the neck and arm inorder to aggravate or relieve arm symptoms, are commonly used in clinical practice in patients with a suspected cervical radiculopathy. Their diagnostic accuracy, however, has never been examined in a systematic review. A comprehensive search was conducted in order to identify all possible studies fulfilling the inclusion criteria. A study was included if: (1) any provocative test of the neck for diagnosing cervical radiculopathy was identified; (2) any reference standard was used; (3) sensitivity and specificity were reported or could be (re-)calculated; and, (4) the publication was a full report. Two reviewers independently selected studies, and assessed methodological quality. Only six studies met the inclusion criteria, which evaluated five provocative tests. In general, Spurling's test demonstrated low to moderate sensitivity and high specificity, as did traction/neck distraction, and Valsalva's maneuver. The upper limb tension test (ULTT) demonstrated high sensitivity and low specificity, while the shoulder abduction test demonstrated low to moderate sensitivity and moderate to high specificity. Common methodological flaws included lack of an optimal reference standard, disease progression bias, spectrum bias, and review bias. Limitations include few primary studies, substantial heterogeneity, and numerous methodological flaws among the studies; therefore, a meta-analysis was not conducted. This review suggests that, when consistent with the history and other physical findings, a positive Spurling's, traction/neck distraction, and Valsalva's might be indicative of a cervical radiculopathy, while a negative ULTT might be used to rule it out. However, the lack of evidence precludes any firm conclusions regarding their diagnostic value, especially when used in primary care. More high quality studies are necessary in order to resolve this issue.

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Section: Discussionmentioning

confidence: 99%