Upper Limb Tension Tests (ULTTs): Difference between revisions
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ULTTs aim at evoking the patients symptoms. This is done by keeping the shoulder, elbow, forearm, wrist and fingers in specific position to put stress on particular nerve (nerve bias)<ref name=":02">Butler DS: Mobilisation of the nervous system, Melbourne, 1991, Churchill Livingstone.</ref> and further modification in position of each joint is done as "sensitiser". <ref>Flynn TW, Cleland JA, Whitman JM. Users' Guide To The Musculoskeletal Examination. Evidence in Motion; 2008.</ref> | ULTTs aim at evoking the patients symptoms. This is done by keeping the shoulder, elbow, forearm, wrist and fingers in specific position to put stress on particular nerve (nerve bias)<ref name=":02">Butler DS: Mobilisation of the nervous system, Melbourne, 1991, Churchill Livingstone.</ref> and further modification in position of each joint is done as "sensitiser". <ref>Flynn TW, Cleland JA, Whitman JM. Users' Guide To The Musculoskeletal Examination. Evidence in Motion; 2008.</ref> | ||
General points that need to be kept in mind while performing the test. | General points that need to be kept in mind while performing the test.<ref name=":0">Shacklock M. Clinical neurodynamics: a new system of neuromusculoskeletal treatment. Elsevier Health Sciences; 2005 May 6.</ref> | ||
# Therapist should briflyexplain the patient the procedure they are going to perform in layman terms. This decreases the feeling of anticipation among the patient and they are more calm and relaxed. Inform the patient that it may or may not evoke the symptoms and to communicate verbally when patient feels any kind of discomfort. | # Therapist should briflyexplain the patient the procedure they are going to perform in layman terms. This decreases the feeling of anticipation among the patient and they are more calm and relaxed. Inform the patient that it may or may not evoke the symptoms and to communicate verbally when patient feels any kind of discomfort. | ||
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===== Indications- ===== | ===== Indications-<ref name=":0" /> ===== | ||
# Radiating pain in the upper limb | # Radiating pain in the upper limb | ||
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===== Indications ===== | ===== Indications<ref name=":0" /> ===== | ||
# Recent shoulder arthroplasty surgery | # Recent shoulder arthroplasty surgery | ||
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# Supinator tunnel syndrome | # Supinator tunnel syndrome | ||
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===== Indications ===== | ===== Indications<ref name=":0" /> ===== | ||
# Pain radiating to 4th and 5th digits | # Pain radiating to 4th and 5th digits | ||
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'''Reliability''' | '''Reliability''' | ||
Inter-examiner Kappa= .76<br> | Inter-examiner Kappa= .76 | ||
According to a study the ULTTs have moderate to substantial reliability.<ref>Schmid AB, Brunner F, Luomajoki H, Held U, Bachmann LM, Künzer S, Coppieters MW. Reliability of clinical tests to evaluate nerve function and mechanosensitivity of the upper limb peripheral nervous system. BMC musculoskeletal disorders. 2009 Dec;10(1):1-9.</ref><br> | |||
== Resources == | == Resources == |
Revision as of 21:49, 26 November 2021
Original Editor - Jennifer Self
Top Contributors - Kim Jackson, Admin, Adrianna Simmons, Jennifer Self, Hetvi Gala, Evan Thomas, Aminat Abolade, Cindy John-Chu, Jeannine Escobar, Johnathan Fahrner, WikiSysop, Claire Knott and Lucinda hampton
Introduction[edit | edit source]
The Brachial Plexus Tension or Elvey Test, also known as Upper Limb Tension Tests,[1] are designed to put stress on neurological structures of upper limb by elongating them. These tests were first described by Elvey[2] and hence also known as Elvey test but most commonly called ULTT. The ULTT's are equivalent to the straight leg raise designed for the lumbar spine.
Purpose[edit | edit source]
These tension tests are performed to check the peripheral nerve compression or as a part of neurodynamic assessment. These tests are performed as a cluster to make a confirmatory diagnosis for nerve involvement. These tests are both diagnostic and therapeutic. Once the diagnosis of is made the tests are done to mobilise the entrapped nerve
Technique[edit | edit source]
ULTTs aim at evoking the patients symptoms. This is done by keeping the shoulder, elbow, forearm, wrist and fingers in specific position to put stress on particular nerve (nerve bias)[3] and further modification in position of each joint is done as "sensitiser". [4]
General points that need to be kept in mind while performing the test.[5]
- Therapist should briflyexplain the patient the procedure they are going to perform in layman terms. This decreases the feeling of anticipation among the patient and they are more calm and relaxed. Inform the patient that it may or may not evoke the symptoms and to communicate verbally when patient feels any kind of discomfort.
- Care should me taken to just evoke the symptoms and not further aggravate the symptoms.
- Each test is done on the normal/asymptomatic side first.
- Perform the test slowly and gently and maintain each movement precisely.
- The final movement should not be held for more than 10 secs
- Keep a watch for unwanted movements which might alter the results. Traditionally for the upper limb, the order of joint positioning is shoulder followed by forearm, wrist, fingers, and lastly elbow. Each joint positioning component is added until the pain is provoked or symptoms are reproduced. To further sensitize the upper limb tests, side flexion of cervical spine can be added[4]. If pain is provoked in the very initial position, then there is no need to add further sensitisers.
Positive Test
The test is positive if one or more of the following occurs:
- Symptoms reproduced
- Side to side difference in elbow extension greater than 10 degrees
- Contralateral cervical side bending increases symptoms, or ipsilateral side bending decreases symptoms
Upper Limb Tension Test 1 (ULTT1, Median nerve bias)[edit | edit source]
Indications-[5][edit | edit source]
Movements performed[edit | edit source]
Structural differentiation[edit | edit source]
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[6] |
Upper Limb Tension Test 2A (ULTT2A, Median nerve bias)[edit | edit source]
Indications[5][edit | edit source]
Movements performed[edit | edit source]
Structural differentiation[edit | edit source]
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[7] |
Upper Limb Tension Test 2B (ULTT2B, Radial nerve bias)[edit | edit source]
Indications-[5][edit | edit source]
Movements performed[edit | edit source]
Structural differentiation[edit | edit source]
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[8] |
Upper Limb Tension Test 3 (ULTT3, Ulnar nerve bias)[edit | edit source]
Indications[5][edit | edit source]
Movements performed[edit | edit source]
Structural Differentiation[edit | edit source]
|
[9] |
Evidence[edit | edit source]
Diagnostic Accuracy[10]
Reference standard cervical radiculopathy as diagnosed by needle electromyography and nerve conduction studies.
Sensitivity= .50
Specificity= .86
-LR= .58
+LR= 3.5
Reliability
Inter-examiner Kappa= .76
According to a study the ULTTs have moderate to substantial reliability.[11]
Resources[edit | edit source]
For more information visit this Physiopedia page Neurodynamic Assessment
References[edit | edit source]
- ↑ Magee DJ.Orthopaedic physical assessment.5th edition.Elsevier publication.
- ↑ Elvey RL: The investigation of arm pain. In Boyling JD, Palastanga N (eds): Grieve’s modern manual therapy: the vertebral column, 2nd ed. Edinburgh, 1994, Churchill Livingstone.
- ↑ Butler DS: Mobilisation of the nervous system, Melbourne, 1991, Churchill Livingstone.
- ↑ Flynn TW, Cleland JA, Whitman JM. Users' Guide To The Musculoskeletal Examination. Evidence in Motion; 2008.
- ↑ 5.0 5.1 5.2 5.3 5.4 Shacklock M. Clinical neurodynamics: a new system of neuromusculoskeletal treatment. Elsevier Health Sciences; 2005 May 6.
- ↑ Physical Therapy Nation.Upper Limb Tension Test (Median Nerve Bias). Available from: http://www.youtube.com/watch?v=g3DSgCOXpWc [last accessed 24/10/2020]
- ↑ Jason Craig. Upper Limb Tension Test 2a (Median Nerve). Available from: http://www.youtube.com/watch?v=Y4j7dQs0UVM [last accessed 24/10/2020]
- ↑ Physical Therapy Nation. Upper Limb Tension Test (Radial Nerve Bias). Available from: http://www.youtube.com/watch?v=x3ivtuDwCDI [last accessed 24/10/2020]
- ↑ Physical Therapy Nation. Upper Limb Tension Test (Ulnar Nerve Bias). Available from: http://www.youtube.com/watch?v=wKnpaf7OI7s [last accessed 24/10/2020]
- ↑ Hartley A. Practical Joint Assessment. St Louis: Mosby; 1995.
- ↑ Schmid AB, Brunner F, Luomajoki H, Held U, Bachmann LM, Künzer S, Coppieters MW. Reliability of clinical tests to evaluate nerve function and mechanosensitivity of the upper limb peripheral nervous system. BMC musculoskeletal disorders. 2009 Dec;10(1):1-9.