Upper limb neural tissue

tension test
PRESENTED BY: PRANAV ARUN
ROLL NUMBER: 211102104
MODERATED BY: MRS ANUPAMA PRABHU
Learning Objectives
• What is Neural Tissue Tension Test?
• How is the test performed?
• ULTT 1 Test
• How to perform ULTT 1 Test?
• ULTT 2 Test
• How to perform ULTT 2 Test?
• ULTT 3 Test
• How to perform ULTT 3 Test?
• ULTT 4 Test
• How to perform ULTT 4 Test?
• When is the test considered positive?
What is Neural Tissue Tension Test?
• Also known as Brachial Plexus Tension or Elvey Test.
• They are tension tests designed to put stress on the
neurological structures of the upper limb by stretching them.
• Performed to check the peripheral nerve compression or as part
of neurodynamic assessment.
• These tests are both diagnostic and therapeutic.
• After diagnosis is made, the tests are done to mobilise the
entrapped nerve.
How is the test performed?
• Test is performed on the normal/asymptomatic side first.
• For the upper limb, the order of joint positioning is shoulder followed by
forearm, wrist, fingers and then the elbow.
• Each joint positioning component is added until the pain is provoked or
symptoms are reproduced.
• To further sensitise the upper limb tests, side flexion of the cervical spine
can be done.
• When positioning the shoulder, constant depression force can be applied
to the shoulder girdle so that with abduction, shoulder girdle remains
depressed.
ULTT 1 Test
• Test that applies stress on the median nerve + anterior
interosseous nerve and nerve roots of C5-C7.
• Indications:
• Radiating pain in the upper limb.
• Tingling sensations in the first 3 fingers.
How to perform ULTT 1 test?
• Depress patient’s shoulder.
• Abduct arm to 110 degrees.
• Flex elbow to 90 degrees.
• Externally rotate the shoulder.
• Supinate forearm.
• Extend wrist and fingers.
• Slowly extend the elbow until symptoms are provoked.
• Ask patient to laterally flex neck to opposite direction which
would increase tension again.
ULTT 2 Test
• Test that puts stress on the median nerve, axillary nerve and
musculocutaneous nerve.
• Indications:
• Radiating pain in the upper limb.
• Recent shoulder arthroplasty surgery.
• Tingling sensations in the first 3 fingers.
• Recent dislocation of shoulder and instability.
How to perform ULTT 2 test?
• Depress patient’s shoulder.
• Abduct arm to 10 degrees.
• Flex elbow to 90 degrees.
• Supinate forearm.
• Extend wrist and fingers.
• Slowly extend the elbow until symptoms are provoked.
• Ask patient to laterally flex neck to opposite direction which
would increase tension again.
ULTT 3 Test
• Test that puts stress on the radial nerve.
• Indications:
• Radiating pain in the upper limb.
• Supinator tunnel syndrome.
• De Quervain’s disease.
• Cervical Radiculopathy.
How to perform ULTT 3 Test?
• Depress patient’s shoulder.
• Abduct arm to 10 degrees.
• Flex elbow to 90 degrees.
• Pronate forearm.
• Flex wrist and fingers.
• Slowly extend the elbow until symptoms are provoked.
• Ask patient to laterally flex to opposite direction which would
increase tension again.
ULTT 4 Test
• Test that puts stress on ulnar nerve and nerve roots C8 and T1.
• Indications:
• Pain radiating to the 4th and 5th digits.
• Thoracic outlet syndrome.
• Carpal tunnel syndrome.
How to perform ULTT 4 Test?
• Depress patient’s shoulder.
• Abduct arm to 90 degrees.
• Pronate forearm.
• Extend wrist and fingers.
• Laterally rotate shoulder.
• Slowly bring fingers towards ear until symptoms are provoked.
• Ask patient to laterally flex neck to opposite direction which
would increase tension again.
When is the test considered positive?
• Pain or sensations of tingling or numbness are experienced at
any stage during movement into the test position or during
addition of sensitisation maneuvers
• Reproduction of neck, shoulder or arm symptoms
• Contralateral cervical lateral flexion increases symptoms while
ipsilateral cervical lateral flexion reduces the symptoms.
Summary
• What is Neural Tissue Tension Test?
• How is the test performed?
• ULTT 1 Test
• How to perform ULTT 1 Test?
• ULTT 2 Test
• How to perform ULTT 2 Test?
• ULTT 3 Test
• How to perform ULTT 3 Test?
• ULTT 4 Test
• How to perform ULTT 4 Test?
• When is the test considered positive?
References

• Orthopedic Physical Assessment by David Magee

• Neurodynamic Assessment - Physiopedia (physio-pedia.com)
• Neural Tissue Tension Techniques - Upper Limb, Lower limb tes
t (mobilephysiotherapyclinic.in)
Thank You