Valsalva Maneuver | Cervical Radicular Syndrome Assessment

The Valsalva maneuver increases the intraspinal pressure which in turn can exacerbate neuropathies or radicular pain.

According to Wainner et al. (2003), it has a sensitivity of 22% and a specificity of 94%in the detection of Cervical Radicular Syndrome. It can therefore be used to increase the post-test chance of having cervical radiculopathy but still has a rather weak clinical utility as a stand-alone test.

To perform the test have your patient in sitting position. Then ask your patient to take a deep breath and hold the breath while attempting to exhale over a two to three-second period with gradually increasing force. Some people might find it easier to blow against the back of the hand or think of bearing down as in performing a toilet procedure or equalizing ear pressure during diving.

This test is positive if the patient’s arm pain or paresthesia is reproduced.

Other common tests to assess cervical radicular syndrome are:

• Upper Limb Tension Test 1 / ULNT A
• Cervical Distraction Test
• Spurling’s Test
• Cluster of Wainner

21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE

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Wainner RS, Fritz JM, Irrgang JJ, Boninger ML, Delitto A, Allison S. Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy. Spine. 2003 Jan 1;28(1):52-62.