What are Upper Limb Tension Tests (ULTTs)?

The Upper Limb Tension Tests, also known as the upper limb neurodynamic tests, are designed to help the practitioner, specifically those specializing in physical therapy or neurology, assess the neurological structures of a patient’s limb—its length and mobility—by increasing the neural tension in particular nerves. It proves to be helpful when diagnosing for certain conditions including, but not limited to, cervical radiculopathy and carpal tunnel syndrome. Usually, these tests are part of a neurodynamic assessment to identify if the patient has cervical radiculopathy, a “pinched nerve,” or even peripheral neuropathy.

There are four Upper Limb Tension Tests, and among the three names they have, one is based on the nerve they are placing pressure on to test. To enumerate, here are the four tests:

• Elvey's ULTT1 or ULTT A or Median Nerve Bias (Magee-ULTT 1)
• Elvey's ULTT2A or ULTT B or Median Nerve Bias (Magee-ULTT 2)
• Elvey's ULTT2B or ULTT C or Radial Nerve Bias (Magee-ULTT 3)
• Elvey's ULTT3 or ULTT D or Ulnar Nerve Bias (Magee-ULTT 4)

Robert Elvey initially developed these tests (1986), but Magee had a different naming convention in the 7th edition of his book Orthopedic Physical Assessment (2020), which may cause some confusion.

These tests have a wide range of clinical applications, including diagnosing nerve compression or irritation in the upper limb. Although a study that had to evaluate test procedures stated that the tests, more specifically ULTT1, requires attention by future diagnostic accuracy studies to create a more standardised test procedure with accompanying positive diagnostic criteria (Verhagen et al., 2023). When these tests are used in conjunction with others, each one's associated positive diagnostic criteria allow you to gain a thorough understanding of the patient's condition that can help with formulating treatment plans.

How does our Upper Limb Tension Tests template work?

To make the most out of our Upper Limb Tension Tests template, follow the steps below.

Step 1: Access the template

To access and download our upper limb tension test PDF template, you can do either of the following:

• Click the “Use template” or "Download" buttons.
• Go to Carepatron's template library on our website or app and search for “Upper Limb Tension Tests.”

Fill out the basic information, such as the patient's name, examiner's name, and exam date. At this point, it's also best to explain to the patient what you're going to do and to let you know if they're feeling the symptoms, pain, or discomfort even at the beginning of the test.

Step 2: Conduct the tests

On our template, you’ll find instructions for the four Upper Limb Tension Tests mentioned above. To conduct each, you simply have to follow the steps or proposed test procedure provided.

Step 3: Record the results and interpret

After every test, you must record the results by ticking the “positive” or “negative” checkbox according to the patient's reaction. We've provided a guide on our template on knowing if your patient is positive for the test. To give you an idea, common criteria for a positive test include reproduction of pain or other neural symptoms, parasthesia, numbness, weakness, fatigue, and decreased range of motion or stiffness.

Feel free to utilize the dedicated space for notes, observations, or reminders that may aid you or fellow practitioners during further testing.

Step 4: Proceed with the next steps

If your patient is positive in any of the tests, you may proceed to do imaging tests to identify and isolate the affected nerve to formulate a diagnosis or treatment plan.

When to use these Upper Limb Tension assessments?

As a medical professional, you would know best when to utilize our template and the four tests in it. However, if you need assistance, we’ve provided a list of symptoms and situations wherein you may want to test your patient to confirm your clinical impression or eliminate other diagnoses.

For symptoms, it’s best you conduct the test if they are feeling:

• Upper limb muscle atrophy
• Swelling of the limbs
• Changes in the hands’ sensitivity depending on the nerve damage location
• Soreness, pain, weakness, tingling, or numbing in the arm, shoulder, hand, or fingers
• Involuntary muscle contractions or cramps

For situations, on the other hand, you may want to assess your patient with these tests if they have:

• Vitamin imbalances, especially Vitamin B12
• Swelling or inflammation because of an infection or disease
• A tumor
• Injuries or deformation because of their work or activities
• Undergone surgery
• Experienced trauma to the nerve, such as a tear, rupture, etc.

Do note that some other symptoms and situations may require you to conduct the Upper Limb Tension Test, and we only provided a handful of common ones that practitioners usually use as a basis.

Benefits of using our free Upper Limb Tension Tests Template

When conducting the Upper Limb Tension Tests, you'll find that have a template will come in handy. Here are a few reasons why:

Easy to learn and use

Since each test only has simple instructions, you and fellow practitioners conducting it can easily understand, learn, and use it in your practice.

Time-saving

It's encouraged that one efficiently performs the test, stopping when the patient verbalizes pain or refraining from keeping a position for too long to not aggravate the patient's symptoms. As a result, time spent performing the physical test is saved without sacrificing the quality of the result.

Moreover, with our template, practitioners don't have to look for a guide on how to do the test or a notepad where they can write the test results.

Written results for future reference

Instead of relying on your memory, a messaging app, or even a sticky note, using our template as the sole document where you write the results you and fellow practitioners can access when needed for future reference. There's no risk of it getting forgotten, buried under messages, or lost.

Accessible

Our template is downloadable and digitally editable. You and fellow practitioners can access the template and the test results anytime, anywhere, and on any gadget you have on hand.

References

Elvey, R. L. (1986). Treatment of arm pain associated with abnormal brachial plexus tension. Australian Journal of Physiotherapy, 32(4), 225–230. https://doi.org/10.1016/s0004-9514(14)60655-3

Schmid, A. B., Brunner, F., Luomajoki, H., Held, U., Bachmann, L. M., Künzer, S., & Coppieters, M. W. (2009). Reliability of clinical tests to evaluate nerve function and mechanosensitivity of the upper limb peripheral nervous system. BMC Musculoskeletal Disorders, 10(1). https://doi.org/10.1186/1471-2474-10-11

Magee, D. J. (2020). Orthopedic physical assessment (7th edition). Elsevier.

Verhagen, A. P., Brown, H., Hancock, M., & Anderson, D. (2023). Test procedures and positive diagnostic criteria of the upper limb tension tests differ: a systematic review of the DiTA database. Brazilian Journal of Physical Therapy, 27(6), 100558. https://doi.org/10.1016/j.bjpt.2023.100558