Cluster of Wainner | Cervical Radicular Syndrome Assessment

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Cluster of Wainner | Cervical Radiculopathy

The cluster of Wainner et al. (2003) consists of 4 different tests to confirm cervical radicular syndrome. 3 positive tests out of 4 yield a positive likelihood ratio of 6.1 and 4 positive tests lead to a positive likelihood ratio of 30.3 .Although this strongly influence the post-test probability, the study has several shortcomings, which is why we assign this cluster only a moderate clinical value.

1. The first test in the cluster of Wainner is the ULTT1, which is the best test to rule out cervical radicular syndrome with a sensitivity of 97% and a specificity of 22%.To perform this test, have your patient in supine lying position. First, depress the shoulder on the affected side, abduct to 110° and bring it into external rotation. Afterward, supinate your patient’s forearm, extend the wrist and fingers and then slowly extend the elbow. You should confirm that you are putting stress on nerve tissue by releasing some of the tension at the elbow and asking your patient to laterally flex his neck to the opposite side, which should increase symptoms again.

This test is positive, if your patient’s complaints like shooting pain down the arm or tingling are reproduced.

2. The second test is cervical rotation. This movement is described to have a high sensitivity of 89% and a low specificity of 49%. To perform the test, ask your patient to rotate his head to the affected side and ideally measure it with an inclinometer or a CROM device as they are more reliable than visual estimation.

This test is considered positive for a rotation lower than 60°.On average you can expect around 80° in the healthy population.

3. The third test is the traction/distraction test. It is reported to have a low sensitivity of 44% and a high specificity of 90%. This test only makes sense if your patient is currently complaining of radiating pain or a burning or tingling sensation in the arm. To perform this test, have your patient in supine position and apply longitudinal traction with your fingers hooked under your patient’s occiput.

This test is considered positive, if your patients familiar arm pain is reduced.

4. The last test in the cluster is Spurling’s test A, which is described with a low sensitivity of 50% and a good specificity of 86%.To perform the test, have your patient in sitting position, ask him to laterally flex his neck to the affected side and apply overpressure of around seven kilograms.

This test is positive if your patient’s familiar arm pain is increased during the test.

Although the Cluster of Wainner is commonly applied in the diagnosis of Cervical Radicular Syndrome, it does have its limitations:– The confidence interval for 4 positive tests is huge and ranges from 1.7 to 538.2 due to a limited sample size.– Additionally, although the symptoms were reported to be mild to moderate, it is questionable if these findings from a study conducted in a hospital setting can be transferred to primary care.

Other common tests to assess for cervical radiculopathy are: