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

Background context In clinical practice, the diagnosis of cervical radiculopathy is based on information from the patient history, physical examination and diagnostic imaging. Various physical tests may be performed, but their diagnostic accuracy is unknown. Purpose 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 Review of the accuracy of diagnostic tests. Study Sample 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. 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 0.89-1.00 (95%CI: 0.59-1.00); sensitivity varied from 0.38-0.97 (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 the 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 negative combined neurodynamic testing and an Arm Squeeze test could be used to rule out the disorder.