Value of physical tests in diagnosing cervical radiculopathy: a systematic review

Thoomes, EJ; van Geest, S; van der Windt, DA; Falla, D; Verhagen, AP; Koes, BW; Thoomes-de Graaf, M; Kuijper, B; Scholten-Peeters, WGM; Vleggeert-Lankamp, CL

Value of physical tests in diagnosing cervical radiculopathy: a systematic review

Thoomes, EJ van Geest, S van der Windt, DA Falla, D Verhagen, AP

Koes, BW Thoomes-de Graaf, M Kuijper, B Scholten-Peeters, WGM Vleggeert-Lankamp, CL

Permalink

Publication Type:: Journal Article
Citation:: Spine Journal, 2018, 18 (1), pp. 179 - 189
Issue Date:: 2018-01-01

Open Access

Copyright Clearance Process

Recently Added
In Progress
Open Access

This item is open access.

Adobe PDF

Download Accepted Manuscript VersionAdobe PDF (764.44 kB)

View on publisher's site

View statistics

Full metadata record

Field	Value	Language
dc.contributor.author	Thoomes, EJ	en_US
dc.contributor.author	van Geest, S	en_US
dc.contributor.author	van der Windt, DA	en_US
dc.contributor.author	Falla, D	en_US
dc.contributor.author	Verhagen, AP https://orcid.org/0000-0002-6195-0128	en_US
dc.contributor.author	Koes, BW	en_US
dc.contributor.author	Thoomes-de Graaf, M	en_US
dc.contributor.author	Kuijper, B	en_US
dc.contributor.author	Scholten-Peeters, WGM	en_US
dc.contributor.author	Vleggeert-Lankamp, CL	en_US
dc.date.available	2017-08-15	en_US
dc.date.issued	2018-01-01	en_US
dc.identifier.citation	Spine Journal, 2018, 18 (1), pp. 179 - 189	en_US
dc.identifier.issn	1529-9430	en_US
dc.identifier.uri	http://hdl.handle.net/10453/128460
dc.description.abstract	© 2017 Elsevier Inc. Background Context In clinical practice, the diagnosis of cervical radiculopathy is based on information from the patient's history, physical examination, and diagnostic imaging. Various physical tests may be performed, but their diagnostic accuracy is unknown. Purpose This study aimed to summarize and update the evidence on diagnostic performance of tests carried out during a physical examination for the diagnosis of cervical radiculopathy. Study Design A review of the accuracy of diagnostic tests was carried out. Study Sample The study sample comprised diagnostic studies comparing results of tests performed during a physical examination in diagnosing cervical radiculopathy with a reference standard of imaging or surgical findings. Outcome Measures Sensitivity, specificity, likelihood ratios are presented, together with pooled results for sensitivity and specificity. Methods A literature search up to March 2016 was performed in CENTRAL, PubMed (MEDLINE), Embase, CINAHL, Web of Science, and Google Scholar. The methodological quality of studies was assessed using the QUADAS-2. Results Five diagnostic accuracy studies were identified. Only Spurling's test was evaluated in more than one study, showing high specificity ranging from 0.89 to 1.00 (95% confidence interval [CI]: 0.59–1.00); sensitivity varied from 0.38 to 0.97 (95% CI: 0.21–0.99). No studies were found that assessed the diagnostic accuracy of widely used neurological tests such as key muscle strength, tendon reflexes, and sensory impairments. Conclusions There is limited evidence for accuracy of physical examination tests for the diagnosis of cervical radiculopathy. When consistent with patient history, clinicians may use a combination of Spurling's, axial traction, and an Arm Squeeze test to increase the likelihood of a cervical radiculopathy, whereas a combined results of four negative neurodynamics tests and an Arm Squeeze test could be used to rule out the disorder.	en_US
dc.relation.ispartof	Spine Journal	en_US
dc.relation.isbasedon	10.1016/j.spinee.2017.08.241	en_US
dc.subject.classification	Orthopedics	en_US
dc.subject.mesh	Cervical Vertebrae	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Radiculopathy	en_US
dc.subject.mesh	Neurologic Examination	en_US
dc.subject.mesh	Sensitivity and Specificity	en_US
dc.title	Value of physical tests in diagnosing cervical radiculopathy: a systematic review	en_US
dc.type	Journal Article
utslib.citation.volume	1	en_US
utslib.citation.volume	18	en_US
utslib.for	1103 Clinical Sciences	en_US
utslib.for	1109 Neurosciences	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Graduate School of Health
utslib.copyright.status	open_access
pubs.issue	1	en_US
pubs.publication-status	Published	en_US
pubs.volume	18	en_US

Abstract:

© 2017 Elsevier Inc. Background Context In clinical practice, the diagnosis of cervical radiculopathy is based on information from the patient's history, physical examination, and diagnostic imaging. Various physical tests may be performed, but their diagnostic accuracy is unknown. Purpose This study aimed to summarize and update the evidence on diagnostic performance of tests carried out during a physical examination for the diagnosis of cervical radiculopathy. Study Design A review of the accuracy of diagnostic tests was carried out. Study Sample The study sample comprised diagnostic studies comparing results of tests performed during a physical examination in diagnosing cervical radiculopathy with a reference standard of imaging or surgical findings. Outcome Measures Sensitivity, specificity, likelihood ratios are presented, together with pooled results for sensitivity and specificity. Methods A literature search up to March 2016 was performed in CENTRAL, PubMed (MEDLINE), Embase, CINAHL, Web of Science, and Google Scholar. The methodological quality of studies was assessed using the QUADAS-2. Results Five diagnostic accuracy studies were identified. Only Spurling's test was evaluated in more than one study, showing high specificity ranging from 0.89 to 1.00 (95% confidence interval [CI]: 0.59–1.00); sensitivity varied from 0.38 to 0.97 (95% CI: 0.21–0.99). No studies were found that assessed the diagnostic accuracy of widely used neurological tests such as key muscle strength, tendon reflexes, and sensory impairments. Conclusions There is limited evidence for accuracy of physical examination tests for the diagnosis of cervical radiculopathy. When consistent with patient history, clinicians may use a combination of Spurling's, axial traction, and an Arm Squeeze test to increase the likelihood of a cervical radiculopathy, whereas a combined results of four negative neurodynamics tests and an Arm Squeeze test could be used to rule out the disorder.

Please use this identifier to cite or link to this item:

http://hdl.handle.net/10453/128460