User:Drvivek arora/Upper Limb Tension test

Upper Limb Tension Test Peripheral nerves and their roots may become irritated at many points, Elvey demonstrated on cadavers during autopsy that movement of and tension on cervical nerve roots, their investing sheaths, and the dura occur with the movement of the arm in certain planes. The maximum tension on the brachial plexus and on C5, C6 and C7 nerve root complexes occurs with glenohumeral joint horizontal abduction and external rotation, elbow and wrist extension and forearm supination, shoulder girdle depression, and side bending of the cervical spine on the opposite side. Butler advocated the use of four upper limb tension test (ULTTs):

1. ULTT1 - median nerve dominant tension test using shoulder abduction: The ULTT1 positions the patient supine, the arm abducted to 110 degrees, the forearm supinated, and the wrist and fingers extended. The shoulder is externally rotated and then elbow is extended. With this position maintained, cervical side bending first away from and then toward the limb being tested are added. Margarey reported that in performing this test, when side bending of the neck was toward the side of the arm being tested, the patient's symptoms decreased 70% of time. This test assist the clinician in identifying the source of vague or recalcitrant shoulder or upper arm pain. IF this maneuver reproduces the patients arm pain, the test can be broken down into parts to see which components actually insults the brachial plexus.

2. ULTT2a - median nerve dominant tension test using shoulder girdle depression and external rotation of the shoulder: It is predominantly median nerve bias tension test. The patient lies supine with the scapula being free of the table. The examiner's thigh rests against the patient's elbow. The patient's shoulder girdle is depressed, shoulder is abducted 10 degrees, elbow is extended and then arm is externally rotated. The positions is maintained then patient's wrist/fingers/thumb are extended. The most common sensitizing addition is increase in shoulder abduction.

3. ULTT2b - radial nerve dominant tension test using shoulder girdle depression and internal rotation of the shoulder: The ULTT2b radial nerve bias tension test has the same starting position as the ULTT2a test; the difference consist of adding internal rotation of the entire arm with forearm pronation. At this point, the position is held while the patients wrist is flexed, followed by thumb flexion and ulnar deviation.

4. ULTT3 - Ulnar nerve dominant tension test using shoulder abduction and elbow flexion: The ULTT3 differs from ULTT1 and ULTT2 in that it introduces elbow flexion followed by wrist/finger extension.