Upper Limb Tension Tests (ULTTs): Difference between revisions

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== Introduction ==
</div>  
<br>The Brachial Plexus Tension or Elvey Test, also known as Upper Limb Tension Tests,<ref name="magee">Magee DJ.Orthopaedic physical assessment.5th edition.Elsevier publication.</ref> are designed to put stress on neurological structures of upper limb. These tests were first described by Elvey<ref>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.</ref> 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  ==


*To test for the presence of cervical radiculopathy<br>
== Purpose ==
These tension tests are performed to check the peripheral nerve compression or as a part of [https://www.physio-pedia.com/Neurodynamic_Assessment neurodynamic assessment]. The main reason for using a ULTT is to check cervical radiculopathy. These tests are both diagnostic and therapeutic. Once the diagnosis of [https://www.physio-pedia.com/CPR_for_Cervical_Radiculopathy cervical radiculopathy] is made the tests are done to mobilise the entrapped nerve


*A component of the ''Test Item Cluster for the Diagnosis of Cervical Radiculopathy'' to determine the likelihood that a patient has [[CPR for Cervical Radiculopathy|cervical radiculopathy]]<br>
== Technique  ==


== Technique<ref>Flynn TW, Cleland JA, Whitman JM. Users' Guide To The Musculoskeletal Examination. Evidence in Motion; 2008.</ref><br>  ==
The shoulder, elbow, forearm, wrist and fingers are kept in specific position to put stress on particular nerve (nerve bias)<ref name=":0">Butler DS: Mobilisation of the nervous system, Melbourne, 1991, Churchill Livingstone.</ref> and further modification in position of each joint is done as "sensitiser"


The patient is supine. The examiner performs the following movement sequence:
Each test is done on the normal/asymptomatic side first. 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 sensitive the upper limb tests, side flexion of cervical spine can be added[[Neurodynamic Assessment|[4]]]. If pain is provoked in the very initial position, then there is no need to add further sensitisers.


*Scapular depression
If pain or sensations of tingling or numbness are experienced at any stage during movement into the test position or during addition of sensitisation manoeuvres, particularly reproduction of neck, shoulder or arm symptoms, the test is positive; this confirms a degree of mechanical interference affecting neural structures.
=== Upper Limb Tension Test 1 (ULTT1, Median nerve bias)  ===


*Shoulder abduction
{| cellpadding="2" border="0"
|-
| width="300" |
#Shoulder girdle depression
#Shoulder abduction  
#Shoulder external rotation
#Forearm Supination
#Wrist and Finger extension
#Elbow extension
#Cervical side flexion<br>


*Forearm supination, wrist and finger extension
<br>


*Shoulder lateral elevation
See [http://www.physio-pedia.com/Upper_limb_tension_test_A here] for more info on this test.


*Elbow extension
| align="center" width="500" |


*Contralateral/ipsilateral cervical side bending
{{#ev:youtube|g3DSgCOXpWc|400}}<ref>Physical Therapy Nation.Upper Limb Tension Test (Median Nerve Bias). Available from: http://www.youtube.com/watch?v=g3DSgCOXpWc [last accessed 24/10/2020]</ref>
|}


'''Positive Test'''
=== Upper Limb Tension Test 2A (ULTT2A, Median nerve bias)  ===


The test is positive if one or more of the following occurs:
{| cellpadding="2" border="0"
|-
| width="300" |
#Shoulder girdle depression
#Elbow extension
#Lateral rotation of the whole arm
#Wrist, finger and thumb extension<br>


*Symptoms reproduced
| align="center" width="500" |


*Side to side difference in elbow extension greater than 10 degrees
{{#ev:youtube|Y4j7dQs0UVM|400}}<ref>Jason Craig. Upper Limb Tension Test 2a (Median Nerve). Available from: http://www.youtube.com/watch?v=Y4j7dQs0UVM [last accessed 24/10/2020]</ref>
|}


*Contralateral cervical side bending increases symptoms, or ipsilateral side bending decreases symptoms
=== Upper Limb Tension Test 2B (ULTT2B, Radial nerve bias)  ===


<br> {{#ev:youtube|dlGVm4uKCMY}}
{| cellpadding="2" border="0"
|-
| width="300" |
#Shoulder girdle depression
#Elbow extension
#Medial rotation of the whole arm
#Wrist, finger and thumb flexion<br>


<ref>ULTT Median Nerve Bias. (2009, June 8). ClinicallyRelevant.com: Upper Limb Tension Test A [Video]. Retrieved Nov 15, 2009, from http://www.youtube.com/watch?v=dlGVm4uKCMY</ref><br>
| align="center" width="500" |


== Evidence<br> ==
{{#ev:youtube|x3ivtuDwCDI|400}}<ref>Physical Therapy Nation. Upper Limb Tension Test (Radial Nerve Bias). Available from: http://www.youtube.com/watch?v=x3ivtuDwCDI [last accessed 24/10/2020]</ref>
|}


'''Diagnostic Accuracy'''<ref>Hartley A. Practical Joint Assessment. St Louis: Mosby; 1995.</ref>
=== Upper Limb Tension Test 3 (ULTT3, Ulnar nerve bias)  ===


Reference standard cervical radiculopathy as diagnosed by needle electromyography and nerve conduction studies.
{| cellpadding="2" border="0"
|-
| width="300" |
#Shoulder girdle depression
#Shoulder abduction
#Shoulder external rotation
#Wrist and Finger extension
#Elbow flexion
#Shoulder abduction<br>


Sensitivity= .50
| align="center" width="500" |


Specificity= .86
{{#ev:youtube|wKnpaf7OI7s|400}}<ref> Physical Therapy Nation. Upper Limb Tension Test (Ulnar Nerve Bias). Available from: http://www.youtube.com/watch?v=wKnpaf7OI7s [last accessed 24/10/2020]</ref>
|}


-LR= .58
=== Musculocutaneous Nerve Tension Test (ULTT musculocutaneous)  ===


+LR= 3.5
{| cellpadding="2" border="0"
|-
| width="300" |
#Shoulder girdle depression
#Elbow extension
#Shoulder extension
#Ulnar deviation of the wrist with thumb flexion
#Either medial or lateral rotation of the arm could further sensitize this nerve<br>


'''Reliability'''
| align="center" width="500" |


Inter-examiner Kappa= .76<br>  
{{#ev:youtube|iEfZ5GjqylY|400}}<ref>Danielle McNally. Musculocutaneous Nerve Assessment. Available from: http://www.youtube.com/watch?v=iEfZ5GjqylY [last accessed 24/10/2020]</ref>
|}
== Evidence  ==
 
Provide the evidence for this technique here


== Resources  ==
== Resources  ==


For more information visit this Physiopedia page [[Neurodynamic Assessment|Neurodynamic Assessment]]
add any relevant resources here
 
== References  ==


==References==
<references />
<references />  
[[Category:Assessment]]
[[Category:Special_Tests]]
[[Category:Neurodynamics]]
[[Category:Cervical Spine]]
[[Category:Musculoskeletal/Orthopaedics]]
[[Category:EIM_Residency_Project]]
[[Category:Primary Contact]]
[[Category:Cervical Spine - Assessment and Examination]]

Revision as of 16:17, 31 March 2021

Original Editor - User Name
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. 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. The main reason for using a ULTT is to check cervical radiculopathy. These tests are both diagnostic and therapeutic. Once the diagnosis of cervical radiculopathy is made the tests are done to mobilise the entrapped nerve

Technique[edit | edit source]

The shoulder, elbow, forearm, wrist and fingers are kept in specific position to put stress on particular nerve (nerve bias)[3] and further modification in position of each joint is done as "sensitiser"

Each test is done on the normal/asymptomatic side first. 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 sensitive 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.

If pain or sensations of tingling or numbness are experienced at any stage during movement into the test position or during addition of sensitisation manoeuvres, particularly reproduction of neck, shoulder or arm symptoms, the test is positive; this confirms a degree of mechanical interference affecting neural structures.

Upper Limb Tension Test 1 (ULTT1, Median nerve bias)[edit | edit source]

  1. Shoulder girdle depression
  2. Shoulder abduction
  3. Shoulder external rotation
  4. Forearm Supination
  5. Wrist and Finger extension
  6. Elbow extension
  7. Cervical side flexion


See here for more info on this test.

[4]

Upper Limb Tension Test 2A (ULTT2A, Median nerve bias)[edit | edit source]

  1. Shoulder girdle depression
  2. Elbow extension
  3. Lateral rotation of the whole arm
  4. Wrist, finger and thumb extension
[5]

Upper Limb Tension Test 2B (ULTT2B, Radial nerve bias)[edit | edit source]

  1. Shoulder girdle depression
  2. Elbow extension
  3. Medial rotation of the whole arm
  4. Wrist, finger and thumb flexion
[6]

Upper Limb Tension Test 3 (ULTT3, Ulnar nerve bias)[edit | edit source]

  1. Shoulder girdle depression
  2. Shoulder abduction
  3. Shoulder external rotation
  4. Wrist and Finger extension
  5. Elbow flexion
  6. Shoulder abduction
[7]

Musculocutaneous Nerve Tension Test (ULTT musculocutaneous)[edit | edit source]

  1. Shoulder girdle depression
  2. Elbow extension
  3. Shoulder extension
  4. Ulnar deviation of the wrist with thumb flexion
  5. Either medial or lateral rotation of the arm could further sensitize this nerve
[8]

Evidence[edit | edit source]

Provide the evidence for this technique here

Resources[edit | edit source]

add any relevant resources here

References[edit | edit source]

  1. ↑ Magee DJ.Orthopaedic physical assessment.5th edition.Elsevier publication.
  2. ↑ 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.
  3. ↑ Butler DS: Mobilisation of the nervous system, Melbourne, 1991, Churchill Livingstone.
  4. ↑ Physical Therapy Nation.Upper Limb Tension Test (Median Nerve Bias). Available from: http://www.youtube.com/watch?v=g3DSgCOXpWc [last accessed 24/10/2020]
  5. ↑ Jason Craig. Upper Limb Tension Test 2a (Median Nerve). Available from: http://www.youtube.com/watch?v=Y4j7dQs0UVM [last accessed 24/10/2020]
  6. ↑ Physical Therapy Nation. Upper Limb Tension Test (Radial Nerve Bias). Available from: http://www.youtube.com/watch?v=x3ivtuDwCDI [last accessed 24/10/2020]
  7. ↑ Physical Therapy Nation. Upper Limb Tension Test (Ulnar Nerve Bias). Available from: http://www.youtube.com/watch?v=wKnpaf7OI7s [last accessed 24/10/2020]
  8. ↑ Danielle McNally. Musculocutaneous Nerve Assessment. Available from: http://www.youtube.com/watch?v=iEfZ5GjqylY [last accessed 24/10/2020]
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