Upper Limb Tension Tests (ULTTs): Difference between revisions

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== Introduction ==
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}} 
<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.
</div>
== Purpose  ==


== Purpose ==
*To test for the presence of cervical radiculopathy<br>
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


== Technique  ==
*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>


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"
== Technique<ref>Flynn TW, Cleland JA, Whitman JM. Users' Guide To The Musculoskeletal Examination. Evidence in Motion; 2008.</ref>   ==


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.
The patient is supine. The examiner performs the following movement sequence:


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.
*Scapular depression
=== Upper Limb Tension Test 1 (ULTT1, Median nerve bias)  ===


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


<br>
*Forearm supination, wrist and finger extension


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


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


{{#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>
*Contralateral/ipsilateral cervical side bending
|}


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


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


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


{{#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>
*Side to side difference in elbow extension greater than 10 degrees
|}


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


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


| align="center" width="500" |
<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>


{{#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>
== Evidence  ==
|}


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


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


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


{{#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>
Specificity= .86
|}


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


{| cellpadding="2" border="0"
+LR= 3.5
|-
| 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>


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


{{#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>
Inter-examiner Kappa= .76<br>  
|}
== Evidence  ==
 
Provide the evidence for this technique here


== Resources  ==
== Resources  ==


add any relevant resources here
For more information visit this Physiopedia page [[Neurodynamic Assessment|Neurodynamic Assessment]]
 
== 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]]
[[Category:Shoulder - Special Tests]]

Revision as of 17:14, 2 April 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

Purpose[edit | edit source]

  • To test for the presence of cervical radiculopathy
  • A component of the Test Item Cluster for the Diagnosis of Cervical Radiculopathy to determine the likelihood that a patient has cervical radiculopathy

Technique[1][edit | edit source]

The patient is supine. The examiner performs the following movement sequence:

  • Scapular depression
  • Shoulder abduction
  • Forearm supination, wrist and finger extension
  • Shoulder lateral elevation
  • Elbow extension
  • Contralateral/ipsilateral cervical side bending

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


[2]

Evidence[edit | edit source]

Diagnostic Accuracy[3]

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

Resources[edit | edit source]

For more information visit this Physiopedia page Neurodynamic Assessment

References[edit | edit source]

  1. ↑ Flynn TW, Cleland JA, Whitman JM. Users' Guide To The Musculoskeletal Examination. Evidence in Motion; 2008.
  2. ↑ 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
  3. ↑ Hartley A. Practical Joint Assessment. St Louis: Mosby; 1995.
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