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. 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 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

The shoulder, elbow, forearm, wrist and fingers are kept in specific position to put stress on particular nerve (nerve bias) 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.

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)

Shoulder girdle depression Shoulder abduction Shoulder external rotation Forearm Supination Wrist and Finger extension Elbow extension Cervical side flexion See here for more info on this test.

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

Shoulder girdle depression Elbow extension Lateral rotation of the whole arm Wrist, finger and thumb extension

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

Shoulder girdle depression Elbow extension Medial rotation of the whole arm Wrist, finger and thumb flexion

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

Shoulder girdle depression Shoulder abduction Shoulder external rotation Wrist and Finger extension Elbow flexion Shoulder abduction

Musculocutaneous Nerve Tension Test (ULTT musculocutaneous)

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

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