The Cervical Quadrant Test is a cervical spine special test that combines extension, side flexion and rotation, often with gentle axial compression, to reproduce neck or upper-limb symptoms. It is commonly used to support assessment reasoning around cervical radiculopathy, foraminal-closing sensitivity or extension-rotation-sensitive neck pain.
A positive finding may include reproduction of familiar neck, shoulder, arm or hand symptoms, especially symptoms that follow the client’s typical referral pattern. However, the test does not confirm cervical radiculopathy or nerve root compression on its own. It should be interpreted alongside history, neurological screening, cervical range of motion, upper-limb neurodynamic testing, symptom behaviour and other assessment findings.
The Cervical Quadrant Test is commonly used in cervical spine assessment when symptoms may be influenced by extension, rotation or foraminal-closing positions. It is often taught alongside, or as a variation of, Spurling’s Test, cervical foraminal compression testing or neck compression testing.
The test places the neck into a combined position that may reduce space around the intervertebral foramen on the tested side. When symptoms are reproduced, especially arm pain, paraesthesia or familiar referral, the result may support suspicion that cervical nerve root sensitivity is relevant to the presentation.
However, the test must be interpreted carefully. Neck pain, shoulder pain, upper-limb symptoms and neurological symptoms can have many contributors. The Cervical Quadrant Test is not designed to confirm a diagnosis on its own and should not replace a structured assessment.
For Measurz, the value of the test is in consistent recording: side tested, neck position, whether compression was used, symptom location, pain score, neurological symptoms, familiar symptom reproduction, stopping reason and related findings.
Test name: Cervical Quadrant Test
Common related names: Spurling’s Test, foraminal compression test, neck compression test
Region: Cervical spine, shoulder and upper limb
Primary purpose: Assess symptom response to cervical extension, side flexion and rotation, with or without compression
Commonly associated presentation: Cervical radiculopathy-type symptoms or foraminal-closing sensitivity
Positive finding: Familiar neck, shoulder, arm or hand symptoms reproduced during the test
Negative finding: No familiar symptoms and no meaningful side-to-side symptom reproduction
Main limitation: The test does not confirm or exclude cervical radiculopathy on its own.
The Cervical Quadrant Test is a neck special test that moves the cervical spine into a combined position of:
Extension
Side flexion
Rotation
Depending on the variation, gentle axial compression may also be added.
The test is usually performed toward the symptomatic side, but both sides may be assessed for comparison. A positive response is typically based on reproduction of familiar symptoms, especially symptoms that travel into the shoulder, arm or hand.
The test can be used as a symptom provocation test, but it should not be used as a stand-alone diagnostic test.
The Cervical Quadrant Test may be used to support assessment reasoning around:
Cervical radiculopathy-type symptoms
Foraminal-closing sensitivity
Neck pain with referral into the shoulder or arm
Upper-limb paraesthesia or altered sensation
Extension-rotation-sensitive neck pain
Side-to-side cervical symptom comparison
Whether further neurological assessment may be appropriate
Baseline and retest documentation in Measurz
The test is useful because it can reproduce familiar symptoms in a controlled way. It is most meaningful when combined with neurological screening and other cervical radiculopathy tests.
The Cervical Quadrant Test assesses symptom response to a combined cervical closing position.
It may provide information about:
Neck symptom reproduction
Shoulder or arm symptom reproduction
Familiar referral pattern
Side-to-side symptom difference
Extension and rotation sensitivity
Possible foraminal-closing sensitivity
Cervical irritability
Need for further assessment
It does not directly assess:
Nerve root compression with certainty
Disc pathology with certainty
Imaging findings
Cervical joint pathology with certainty
Muscle strength
Upper-limb function
Tissue healing
Readiness for sport or work
Treatment requirement
The Cervical Quadrant Test may be useful for clients with:
Neck pain
Neck pain with arm symptoms
Shoulder or arm symptoms that may be cervical-related
Paraesthesia, tingling or altered sensation requiring assessment
Symptoms worsened by neck extension or rotation
Reduced cervical range of motion
Cervical radiculopathy-type presentation
A need for baseline and retest documentation
It may also be useful for professionals learning how cervical position influences symptom referral.
Consider using the Cervical Quadrant Test when:
Cervical radiculopathy-type symptoms are part of the assessment reasoning
The client reports symptoms into the shoulder, arm or hand
Symptoms appear influenced by neck position
Cervical extension or rotation is relevant
You need to compare left and right symptom response
You have already screened for safety, irritability and neurological concerns
You are building a broader cervical assessment profile
It should generally be used alongside neurological screening, cervical range of motion, distraction testing and upper-limb neurodynamic tests where relevant.
Use caution or avoid the test when:
Red flag features are present
There is recent significant trauma
Cervical fracture, instability, infection, cancer or inflammatory pathology is suspected
Severe neurological symptoms are present
Symptoms are rapidly worsening
The client has signs of cervical myelopathy
Dizziness, drop attacks or vascular-type symptoms are reported
Cervical extension or compression is highly irritable
The professional cannot perform the test safely
Stop immediately if symptoms increase sharply, neurological symptoms worsen, dizziness occurs, the client feels unsafe, or the client asks to stop.
The Cervical Quadrant Test usually requires no equipment.
Optional equipment includes:
Measurz app
Pain rating scale
Neurological screen record
Cervical range of motion tool
Notes field for symptom location, side, compression and stopping reason
Video recording for education only where appropriate
Explain the test before performing it.
A useful explanation is:
“I am going to gently guide your neck into a combined position and ask whether it reproduces your familiar symptoms. Tell me immediately if you feel arm symptoms, tingling, dizziness, sharp pain or anything concerning.”
Decide whether you will perform the test:
Without compression first
With gentle compression only if appropriate
Seated
Standing
Toward the symptomatic side
Bilaterally for comparison
Record the variation used.
The client may sit upright or stand, depending on the setting and safety.
For most assessment situations, seated is preferred because it provides better control.
The client should:
Sit tall
Keep shoulders relaxed
Keep eyes open
Report symptoms clearly
Avoid forcing the neck independently
The professional stands behind or slightly beside the client.
The professional should be able to guide the head and neck safely, monitor symptoms and stop the test quickly.
Place both hands gently around the head and upper cervical region.
Avoid gripping tightly or applying sudden force.
If compression is used, it should be gentle, controlled and applied only after positioning is tolerated.
The trunk should remain still.
Do not force the shoulders down or aggressively stabilise the body. The goal is controlled symptom assessment, not maximal range.
Guide the cervical spine into:
Extension
Rotation toward the test side
Side flexion toward the test side
If appropriate, apply gentle axial compression downward through the head and cervical spine.
The test should be slow and controlled.
Tell the client:
“Let me guide the movement. Tell me if this reproduces your familiar symptoms and exactly where you feel them. Let me know immediately if symptoms travel into the arm or if you feel dizzy or unwell.”
A positive finding may include:
Familiar neck symptoms reproduced
Familiar shoulder, arm or hand symptoms reproduced
Paraesthesia or tingling reproduced in the client’s usual pattern
Reproduction of familiar radiating symptoms
Clear side-to-side difference
Symptoms increased by compression
Symptoms that match the clinical history
The symptom location and quality must be recorded.
A negative finding may include:
No familiar symptoms
No arm or hand symptoms
No meaningful side-to-side difference
Only mild local stretch or non-familiar discomfort
No relevant symptom reproduction
A negative finding does not fully exclude cervical radiculopathy or other cervical involvement.
Stop the test if:
Arm symptoms increase sharply
Neurological symptoms worsen
Dizziness, nausea or visual disturbance occurs
The client reports severe pain
The client asks to stop
The professional feels the test is unsafe
Symptoms do not settle appropriately
Do not perform the test aggressively. Avoid bouncing, sudden compression or forcing end range. Safety screening is essential before cervical compression tests.
A positive Cervical Quadrant Test may increase suspicion that cervical positioning contributes to the client’s symptoms. If the test reproduces familiar arm symptoms, tingling or referral in a pattern consistent with the history, it may support assessment reasoning around cervical radiculopathy-type involvement.
However, a positive test does not confirm cervical radiculopathy, foraminal stenosis, disc pathology or nerve root compression. Symptoms can be influenced by joints, muscles, neural tissues, irritability, fear, guarding or other cervical and shoulder contributors.
A negative Cervical Quadrant Test may reduce suspicion that this cervical closing position is a major symptom driver, particularly when other radiculopathy tests are also negative and the neurological screen is reassuring. However, a negative result does not fully exclude cervical radiculopathy or other cervical contributions.
The finding is more meaningful when interpreted with:
History
Symptom distribution
Neurological screen
Reflexes, sensation and myotomes
Cervical range of motion
Distraction Test
Upper Limb Neurodynamic Test
Shoulder Abduction Relief Test
Shoulder assessment
Functional and work/sport demands
Imaging or referral findings where relevant
Diagnostic accuracy varies depending on the exact version of the test, population and reference standard.
Recent systematic review evidence for physical examination tests in painful cervical radiculopathy reported that versions of Spurling’s Test had:
Condition or presentation: Painful cervical radiculopathy
Population: Adults with suspected cervical radiculopathy across diagnostic studies
Test variation: Spurling’s Test / foraminal compression / cervical quadrant-type variations
Reference standard: Varied across studies, including imaging, electrodiagnostic testing and clinical reference standards
Sensitivity: Reported range approximately 0.38 to 0.98
Specificity: Reported range approximately 0.84 to 1.00
Positive likelihood ratio: Generally more useful when specificity is high, but varies by study
Negative likelihood ratio: Variable; a negative test does not confidently exclude cervical radiculopathy on its own
Key limitations: Different test variations, reference standards, populations and certainty of evidence.
Plain-language interpretation:
Higher specificity means a positive test may increase suspicion when symptoms match the history.
Variable sensitivity means a negative test should not be used alone to exclude cervical radiculopathy.
The test is more useful when combined with neurological screening and other cervical radiculopathy tests.
The result should be recorded as symptom provocation, not as diagnostic confirmation.
Reliability depends on standardising the exact test variation.
Reliability may be affected by:
Seated versus standing position
Amount of extension
Amount of rotation
Amount of side flexion
Whether compression is used
Compression force
Client irritability
Definition of a positive result
Whether local neck pain or arm symptoms are counted
Professional experience
Validity is stronger when the test is interpreted as one part of a cervical radiculopathy cluster. It is weaker when used alone to identify a specific structure or condition.
Reliability improves when the professional records:
Version used
Side tested
Compression used or not used
Symptom location
Neurological symptoms
Pain score
Familiarity of symptoms
Reason for stopping
Comparison side
Common errors include:
Applying compression too early
Applying excessive force
Moving too quickly
Not screening for red flags or neurological concerns
Not recording symptom location
Counting non-familiar local neck discomfort as a clear positive
Ignoring dizziness or vascular-type symptoms
Not comparing sides
Using the test as a stand-alone diagnosis
Not combining with neurological examination
Limitations include:
Test names and variations differ
Diagnostic accuracy varies widely
Compression may be inappropriate for some clients
Negative results do not exclude radiculopathy
Local neck pain is less specific than familiar arm symptoms
A single positive result does not confirm nerve root compression
Symptoms may be influenced by shoulder or upper-limb conditions
The Cervical Quadrant Test may be useful for:
Cervical radiculopathy-type assessment reasoning
Recording cervical closing-position symptom response
Comparing left and right cervical symptoms
Supporting neurological screen interpretation
Deciding whether further assessment is needed
Client education about symptom-provoking positions
Baseline and retest documentation in Measurz
In Measurz, it can be recorded alongside cervical range of motion, neurological screen, Distraction Test, Upper Limb Neurodynamic Test, Shoulder Abduction Relief Test, shoulder tests and functional assessment.
Record:
Test name: Cervical Quadrant Test
Related variation: Spurling/foraminal compression if used
Side tested
Position: seated or standing
Compression used: yes or no
Result: positive, negative, unclear or unable to test
Pain score
Symptom location
Symptom quality
Arm or hand symptoms
Neurological symptoms
Whether symptoms were familiar
Direction tested
Irritability
Reason for stopping if relevant
Comparison side
Related neurological findings
Confidence in interpretation
Further assessment or referral notes if appropriate
Retest date if relevant
Recording these details improves repeatability, communication, client education, assessment reasoning, monitoring over time, team consistency and reporting quality.
Cervical Distraction Test
Spurling’s Test
Upper Limb Neurodynamic Test
Shoulder Abduction Relief Test
Cervical Range of Motion
Neurological Screen
Shoulder assessment
AC Shear Test
Drop Arm Test
Scapular Assistance Test
They are closely related and often overlap. Both use cervical extension, side flexion and rotation, with some versions adding compression.
A positive finding may include reproduction of familiar neck, shoulder, arm or hand symptoms, especially if symptoms match the client’s typical referral pattern.
No. It may increase suspicion, but it does not confirm cervical radiculopathy on its own.
No. Sensitivity varies, so a negative test does not fully exclude cervical radiculopathy.
No. Compression should only be used when appropriate and after the position is tolerated.
Familiar arm symptoms, paraesthesia or referral patterns are usually more meaningful than vague local neck discomfort.
Stop with sharp pain, worsening neurological symptoms, dizziness, visual symptoms, nausea, distress or if the client asks to stop.
History, neurological screening, cervical range of motion, Distraction Test, Upper Limb Neurodynamic Test and shoulder assessment.
The Cervical Quadrant Test assesses symptom response to cervical extension, rotation and side flexion.
It overlaps with Spurling’s Test and foraminal compression variations.
A positive test may increase suspicion of cervical radiculopathy-type involvement when symptoms match the history.
A negative test does not fully exclude cervical radiculopathy.
Diagnostic accuracy varies across studies and test variations.
Measurz recording should include side, position, compression, symptom location, neurological symptoms and comparison side.
Childress, M. A., & Becker, B. A. (2016). Nonoperative management of cervical radiculopathy. American Family Physician, 93(9), 746–754.
Lin, L. H., Lin, T. Y., Chang, K. V., Tzang, C. C., Wu, W. T., & Özçakar, L. (2025). Diagnostic performance of Spurling’s test for the assessment of sub-acute and chronic cervical radiculopathy: A systematic review and meta-analysis. American Journal of Physical Medicine & Rehabilitation, 104(8), 717–723.
Rubinstein, S. M., Pool, J. J. M., van Tulder, M. W., Riphagen, I. I., & de Vet, H. C. W. (2007). A systematic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy. European Spine Journal, 16(3), 307–319. https://doi.org/10.1007/s00586-006-0225-6
Thoomes, E. J., van Geest, S., van der Windt, D. A. W. M., Falla, D., Verhagen, A. P., Koes, B. W., & Thoomes-de Graaf, M. (2026). Diagnostic accuracy of physical examination tests for painful cervical radiculopathy: Update of a systematic review and meta-analysis. BMC Musculoskeletal Disorders.
Viikari-Juntura, E. (1989). Interexaminer reliability of observations in physical examinations of the neck. Physical Therapy, 69(2), 152–156.
