Upper Limb Tension Tests (ULTTs)

Original Editor - Jennifer Self

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Introduction

The Brachial Plexus Tension or Elvey Test, also known as Upper Limb Tension Tests, are designed to put stress on neurological structures of upper limb by elongating them. These tests were first described by Elvey 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

Sagittal section of the cervical spine

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

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) and further modification in position of each joint is done as "sensitiser".

General points that need to be kept in mind while performing the test.

1. 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.
2. Care should me taken to just evoke the symptoms and not further aggravate the symptoms.
3. Each test is done on the normal/asymptomatic side first.
4. Perform the test slowly and gently and maintain each movement precisely.
5. The final movement should not be held for more than 10 secs
6. 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)

Indications- Radiating pain in the upper limb Tingling sensations in first 3 fingers Movements performed Shoulder Depression Shoulder Abduction 1100 External rotation Elbow extension Forearm supination Wrist and finger extension Structural differentiation If proximal symptoms to be differentiated- relieve wrist extension If distal symptoms to be differentiated- Contralateral neck flexion See here for more info on this test.

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

Indications Recent shoulder arthroplasty surgery Recent Dislocation of shoulder and Instability Movements performed Shoulder girdle depression Shoulder abduction 100 External Rotation Elbow extension Wrist, finger and thumb extension Structural differentiation Distal symptoms- Remove small amount of shoulder depression Proximal symptoms- Relieve wrist and finger extension

Upper Limb Tension Test 2B (ULTT2B, Radial nerve bias)

Indications- Supinator tunnel syndrome De Quervain`s disease Cervical Radiculopathy Movements performed Shoulder girdle depression Shoulder abduction 100 Internal rotation Elbow extension Wrist, finger and thumb flexion Structural differentiation Proximal symptoms- Release wrist flexion Distal symptoms- Release small amount of depression

Upper Limb Tension Test 3 (ULTT3, Ulnar nerve bias)

Indications Pain radiating to 4th and 5th digits Thoracic outlet syndrome Carpal tunnel syndrome Movements performed Shoulder girdle depression Shoulder abduction 1100 Shoulder external rotation Forearm pronation Wrist and Finger extension Elbow flexion Structural Differentiation Distal symptoms- Release small amount of shoulder depression Proximal symptoms- Release wrist extension

Evidence

Diagnostic Accuracy

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

For more information visit this Physiopedia page Neurodynamic Assessment