Upper limb tension tests (ULTT)

Upper limb tension tests (ULTT)

Upper limb tension tests (ULTT)
The upper limb tension tests (ULTT) are similar to the straight leg raise test (SLR) of the lumbar spine. The tests are designed to put stress on the nerve tissue of the upper extremity, although in reality, stress is put on all structures of the upper extremity. The ULTT test was first described by Elvey1 and has since been divided into four different tests (see table 1). Modification and position of the joints provide more stress on specific nerves.3 Each test the examiner begins with the uninvolved side. Each phase will completed, until the symptoms are reproduced . In order to further sensitize the test, lateral flexion of the cervical spine can be made, to give more or less stress on the nerve tissue during the tests.1,2 The examiner must at all times know that symptoms (table 2) are easier to generate in nerve tissue of the upper extremity than in the lower extremity if tested.3,4 In addition, the examiner must be aware that when the patient is in an acute phase, has cauda equine or is familiar with spinal nerve lesions, these stress tests are absolute contra-indications.
Table 1. Upper Limb Tension Tests Showing Order of Joint Positioning and Nerve Bias
ULTT1 ULTT2 ULTT3 ULTT4
Shoulder Depression and abduction (110*) Depression and abduction (10*) Depression and abduction (10*) Depression and abduction (10-90*) hand towards ear
Elbow Extension Extension Extension Flexion
Forearm Supination Supination Pronation Supination
Wrist Extension Extension Flexion and ulnar deviation Extension and radial deviation
Fingers and thumb Extension Extension Flexion Extension
Shoulder Lateral rotation Medial rotation Lateral rotation
Cervical Spine Contralaterale side flexion Contralaterale side flexion Contralateral side flexion Contralateral side flexion
Nerve Median nerve, anterior interosseous nerve, C5, C6, C7 Median nerve, musculocutaneous nerve and axillary nerve Radial nerve
Table 2. Upper Limb Tension Test: Normal or Pathological signals and symptoms3 
Normal (negative) Pathological (positive)
Deep pain or stretch in the cubital fossa (99%) Reproduction of the symptoms of the patiënt
Deep pain or stretch in the anterior radial aspect of the forearm and radial aspect of the hand (80%) A sensitization of the test into the ipsilateral quadrant
tingling sensations in fingers which are innervated by the stretched nerve Different symptoms between right and left (contralateral quadrant)
Stretch in anterior side (front) shoulder
Above symptoms increase with contralateral cervical lateral flexion
Above symptoms decrease with ipsilateral cervical lateral flexion (70%)
Literature
  1. 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.
  2. Wells P: Cervical dysfunction and shoulder problems, Physiotherapy 68:66-73, 1982.
  3. Butler DS: Mobilisation of the nervous system, Melbourne, 1991, Churchill Livingstone.
  4. Slater H, Butler DS, Shacklock MO: The dynamic central nervous system: Examination and assessment using tension tests. In Boyling JD, Palastanga N (eds): Grieve’s modern manual therapy: the vertebral column, 2nd ed. Edinburgh, 1994, Churchill Livingstone.

 

Phsyical Examination

Video demonstration: How to perform ULTT tests
Median nerve

Radial nerve

Ulnar nerve

 

Evidence Based Practice

Scientific values of the ULTT A and ULTT B tests
ULTT A5
Reliability Specificity (show) Sensitivity (exclude) Odds Ratio
K=0.76 22% 97% Positive likelihood ratios 1.24, negative likelihood ratios 0.14
 ULTT B5                
Reliability Specificity (show) Sensitivity (exclude) Odds Ratio
K=0.83 33% 72% Positive likelihood ratios 1.07, negative likelihood ratios 0.85
Literature
  1. Wainner RS, Fritz JM, Irrgang J, et al: Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy, Spine 28(1):52-62, 2003.

 

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