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Upper Limb Tension Tests (ULTT)

This video will show you how to correctly perform Upper Limb Tension Tests (ULTT) to help assess your arm for musculoskeletal dysfunction. Learn how to complete specific tests to identify any unhealthy restrictions to professional muscle strength and performance.

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Transcript

00:04 - 00:07This has been of The brookbush Institute in this video. We're going to go
00:07 - 00:10over Upper Limb tension tests. I'm gonna have my friend a vet come out. She's gonna
00:10 - 00:13help me demonstrate. Now, these tests are to help us determine whether the
00:13 - 00:16median owner or radial nerve
00:16 - 00:19are involved in our patient's complaint. We
00:19 - 00:22could see these as trying to find
00:22 - 00:25the concordant sign as part of some
00:25 - 00:28nerve dysfunction. Usually we're
00:28 - 00:32using these tests as part of a cervical ridiculopathy cluster
00:31 - 00:34and we'll be going over that in a
00:34 - 00:37later video. Now. The first thing we want to do with these tests is
00:37 - 00:40notice that the patients in supine laying flat.
00:40 - 00:43We don't want to add any tension to the nervous system. For
00:43 - 00:46example by bringing ourselves up into hip
00:46 - 00:49flexion and Hook Line. We want to make sure that the heads
00:49 - 00:52nice and neutral that we have a stable position.
00:52 - 00:55We continue to come back to and then we're going to ask. Hey,
00:55 - 00:57how is your neck feeling right now?
00:58 - 01:01If somebody has a cervical ridiculopathy and
01:01 - 01:04it is irritable, you'll be surprised. Sometimes people
01:04 - 01:06will get a little nerve symptoms just being
01:07 - 01:10Flat back with their cervical spine a little bit and extension.
01:10 - 01:13So it's important that you kind of rate your starting
01:13 - 01:16symptoms. So, you know if the tests actually
01:16 - 01:17change them
01:18 - 01:21Now what we're going to be doing with these tests is essentially
01:21 - 01:24stretching nerves unfortunately nerves are
01:24 - 01:27a little bit more complicated than muscles as far as trying to
01:27 - 01:31stretch them because they go around so many other joints and
01:30 - 01:34have so many ways of relieving tension
01:33 - 01:36and gaining tension depending on what movements are
01:36 - 01:36added.
01:37 - 01:37So
01:38 - 01:41it gets a little complicated. These are gonna take a little bit of practice but
01:41 - 01:44all of the tests start with this.
01:45 - 01:48This little bit of scapular depression.
01:48 - 01:51And as you can imagine if you think of how those
01:51 - 01:54nerves run right off of the brachial
01:54 - 01:57plexus this would stretch the brachial plexus.
01:57 - 02:01So we just want to start out with hey, did
02:00 - 02:02that increase your symptoms at all?
02:02 - 02:05Okay, so if we know this didn't increase the symptoms now,
02:05 - 02:09we need to start loading the nerve further along. We'll
02:08 - 02:10start with the median nerve.
02:11 - 02:14What you're going to do with the median nerve and what I do guys is I
02:14 - 02:17usually use my fist here to kind of brace and
02:17 - 02:19then I'll use my thigh to help me support the arm.
02:20 - 02:21Okay.
02:21 - 02:24And then we'll go ahead and with the media nerve bring
02:24 - 02:25up to a hundred and ten degrees.
02:27 - 02:29All right. So right about there and go. Hey, how does that feel?
02:30 - 02:31Line if that feels fine.
02:32 - 02:36We're going to now do this funny hand position thing. Alright, you
02:35 - 02:38guys have seen these on some of those nerves tension tests.
02:38 - 02:41I'm sure before but notice how I'm using
02:41 - 02:44my pinky to get across all of her fingers. I have
02:44 - 02:47good purchase of her entire hand. I'm gonna
02:47 - 02:50bring her fingers back into extension her wrist back
02:50 - 02:54into extension and into a little alternate deviation and I
02:53 - 02:55can ask again. How does that feel?
02:56 - 02:59Okay, and I'm gonna bring down to about 90 degrees of external
02:59 - 03:00rotation here. That's okay.
03:01 - 03:05Good, and for most people guys even if they have median
03:04 - 03:07root median nerve involvement.
03:08 - 03:11They're probably still okay here where you usually get things
03:11 - 03:14starting to show some signs of
03:14 - 03:17symptoms is when you go into elbow
03:17 - 03:18extension.
03:20 - 03:23And right about there you can see a vet is starting
03:23 - 03:26to feel it. Now. This actually is not
03:26 - 03:29abnormal and that's not that is something you have to
03:29 - 03:32keep in mind is feeling nervy symptoms.
03:33 - 03:36At let's say within 35 degrees
03:36 - 03:40of elbow extension is not necessarily an
03:39 - 03:42abnormal thing, right? We
03:42 - 03:45need to ask them. Does this bring on the symptoms you
03:45 - 03:45were talking about?
03:46 - 03:49And if it doesn't then it's not what you're looking
03:49 - 03:51for. You might also want to compare sides.
03:52 - 03:56Right if we're talking about a right cervical
03:55 - 03:59ridiculopathy and she's the
03:59 - 04:02same on her right and her left. Well, then we can kind of
04:02 - 04:05determine that this is not as involved. The other
04:05 - 04:08thing you can do for all of these tests is try to
04:08 - 04:09sensitize.
04:10 - 04:14The cervical spine involvement
04:13 - 04:16or sensitize the test to cervical spine
04:16 - 04:20involvement by going. Okay. Let's go lateral flexion.
04:21 - 04:24Increasing tension right and see if that changes this.
04:26 - 04:29If all the sudden she's like oh, right and that brings
04:29 - 04:31on a lot like it magnifies our symptoms.
04:32 - 04:35Then there's a good chance that we have median nerve involvement
04:35 - 04:38from a cervical ridiculopathy. You
04:38 - 04:41could also go the other way we could go. Okay, let's take a bunch
04:41 - 04:44of tension off and see if you get better. Right? So,
04:44 - 04:47you know, the hard part is you got to make sure you get your hand in there
04:47 - 04:50before they get their head down to their shoulder. But if she takes
04:50 - 04:51a bunch of tension off
04:52 - 04:55and all the sudden like all of her symptoms go away.
04:56 - 04:59That's probably a good sign that the cervical spine is involved.
05:00 - 05:04All right guys. So before we go into the other test, let's just take
05:03 - 05:06a quick tally of things that
05:06 - 05:08are going to apply to all your tests.
05:08 - 05:11All of the tests are going to involve this depression
05:11 - 05:14of the shoulder girdle. All right, so that we lengthen
05:14 - 05:17out the brachial plexus all of the tests. You can
05:17 - 05:20sensitize the test to cervical spine involvement
05:20 - 05:23by either increasing tension with lateral flexion
05:23 - 05:26away or decreasing tension with lateral flexion towards
05:27 - 05:29right now the median nerve.
05:30 - 05:33You saw was this funky little movement, right? We're kind
05:33 - 05:33of doing this thing.
05:35 - 05:36So it's
05:37 - 05:41supination and extension of the fingers extension of
05:40 - 05:41the wrists
05:42 - 05:45And then once we get to 110 degrees of
05:45 - 05:45abduction.
05:46 - 05:4890 degrees of elbow extension
05:49 - 05:52We got all of that extended in the hand and wrist then it's
05:52 - 05:55the elbow extension at the end, which is
05:55 - 05:57usually where we start to see funny stuff happen.
05:58 - 06:01Now the owner nerve test.
06:03 - 06:06Is kind of just in the opposite direction. So rather than
06:06 - 06:08supinate we're going to pronate.
06:09 - 06:09rather than
06:10 - 06:13Extend the elbow. We're going to flex the
06:13 - 06:14elbow.
06:15 - 06:18All right you guys with me? So here's what that's going to look like.
06:18 - 06:21You're gonna again depress the shoulder. Hey,
06:21 - 06:24how you doing? It? Everything's okay. Cool back to 110
06:24 - 06:27degrees you okay? Good now watch.
06:28 - 06:30Boom, I just went in the other direction.
06:31 - 06:32Right. How's that feel?
06:33 - 06:36All right. Sometimes you get a little funny stuff. Make sure you guys get the pinky on
06:36 - 06:39this one, right? So make sure you get the pinky extended too. And
06:39 - 06:40then what am I gonna do?
06:41 - 06:42Flex towards her head
06:44 - 06:47Alright, this test is almost like if you
06:47 - 06:50thought about doing this, I don't know if you
06:50 - 06:53guys ever tried to make that face. I can't do it evidently. I have smaller nerves nerve
06:53 - 06:56a my older nerve is not as
06:56 - 06:59extensible as some other people's but if you think about this test for
06:59 - 07:02ulnar nerve and you think about this for median
07:02 - 07:03nerve
07:03 - 07:07you're getting close then it's just a matter of practicing enough.
07:08 - 07:11To get your hand positioned comfortable right? You
07:11 - 07:14guys can notice here that again I'm using my thigh to help.
07:15 - 07:18Now the last one we're going to do which is a little different is
07:18 - 07:20the radial nerve.
07:22 - 07:23now again
07:24 - 07:27Start with depression. Okay. How does
07:27 - 07:27that feel?
07:28 - 07:28That's okay.
07:29 - 07:32Now in this one, I'm going to
07:32 - 07:33ask her to hold her thumb.
07:35 - 07:36Alright, so she's gonna do this.
07:37 - 07:40Because we want we want thumb flexion.
07:41 - 07:43I'm going to totally internally rotate.
07:44 - 07:45and pronate the form
07:46 - 07:49right internally rotate the shoulder pronate the form. Hey,
07:49 - 07:52how does that feel and then the last step? And
07:52 - 07:55again I use my thigh to help me maintain some
07:55 - 07:59elbow extension here is we're gonna add duct or
07:58 - 08:00kind of locked out arm. How does that feel?
08:01 - 08:03now once again guys
08:04 - 08:07feeling feeling nervy stuff.
08:08 - 08:11You know like the little tingly or little shock
08:11 - 08:14once you get out like here is actually pretty
08:14 - 08:15normal.
08:15 - 08:18Right. So let's not let's not make a
08:18 - 08:21positive out of something. That's just normal uncomfortability.
08:21 - 08:24Keep going back to does that bring on
08:24 - 08:27the symptoms you were talking about that concordant sign thing.
08:28 - 08:31Right that was actually fairly normal extensibility
08:31 - 08:34that she felt we saw she had Fairly normal
08:34 - 08:37extensibility on the median nerve test the ulnar
08:37 - 08:39nerve test. She actually had almost like
08:40 - 08:43She had great mobility throughout that position and had
08:43 - 08:46no symptoms at all. So so far with a vet. We're seeing
08:46 - 08:49negative involvement of her
08:49 - 08:52median radial and older nerve.
08:53 - 08:54right
08:54 - 08:57So let's go over that last one one more time.
08:58 - 08:59neutral position
09:01 - 09:02her hand was down by her side.
09:02 - 09:04I had her Tucker thumb.
09:04 - 09:07I'm gonna internally rotate you can kind of look at internally rotating
09:07 - 09:10everything, right so pronation internal rotation of
09:10 - 09:12the shoulder flexion of the wrist.
09:12 - 09:15And then I pull out and abduction checking all
09:15 - 09:18along the way. How do you feel how do you
09:18 - 09:18feel?
09:19 - 09:19How do you feel?
09:20 - 09:21How do you feel?
09:22 - 09:22Good.
09:23 - 09:26Better to be annoying than then did not
09:26 - 09:29ask because if if she was brought on symptoms here,
09:29 - 09:32but you didn't ask until here and then thought she
09:32 - 09:34was normal that's going to give you a false negative.
09:35 - 09:39Right now could I sensitize this test? Absolutely. Can
09:38 - 09:41you laterally flex your head away good?
09:43 - 09:46Did that make things worse? No, can you
09:46 - 09:48go the other way?
09:49 - 09:50Did that make things better?
09:50 - 09:54Yeah, it's so it's
09:53 - 09:56still fine. It's still fine. I didn't actually make her symptoms
09:56 - 09:57better. She just saying she's still fine.
09:58 - 09:58All right.
09:59 - 09:59so
10:01 - 10:04these are gonna take some practice guys and these are some of those tests where let's
10:04 - 10:07be real with each other as professionals. If you
10:07 - 10:10haven't done them in a while chances are you're gonna have to look them back
10:10 - 10:13up. So this might be a video that you want to highlight. I definitely have
10:13 - 10:16to look them back up every once in a while because you know, if I
10:16 - 10:19go a little bit of time without seeing a cervical ridiculopathy, there's
10:19 - 10:22no reason to necessarily do these exams.
10:22 - 10:26You're not going to do them with everybody who walks in the door. Now, we
10:25 - 10:28said that all of the tests start
10:28 - 10:31in the Supine position all of them start with a neutral head position.
10:32 - 10:33all of them start with depression
10:34 - 10:36and then the only thing you have to remember.
10:37 - 10:40Is what movements you're trying to create. So are you
10:40 - 10:40trying to do this?
10:41 - 10:44Are you trying to do this? Are you trying to
10:44 - 10:44do this?
10:45 - 10:48If you guys can remember that you're in really good shape.
10:49 - 10:52if the next thing you can remember is that
10:53 - 10:54elbow extension
10:55 - 10:59and elbow flexion are probably the keys for
10:58 - 11:02the median and ulnar
11:01 - 11:04nerve tests. And abduction is
11:04 - 11:08the key for the radial nerve test as in those
11:07 - 11:10are the movements that generally give you
11:10 - 11:11an indication.
11:12 - 11:15That this is a positive test you've now taken it one
11:15 - 11:16step further.
11:17 - 11:18and of course
11:20 - 11:23when you have complicated things like this as we've said in manual
11:23 - 11:26therapy videos over and over again. Do me a favor.
11:26 - 11:30practice these on your colleagues first colleagues who
11:30 - 11:33can give you some feedback on how it feels so that
11:33 - 11:36before you do this on a patient and look like,
11:36 - 11:37you know,
11:37 - 11:40Muppet hands and just have no
11:40 - 11:40court like
11:42 - 11:44and now it's supposed to be something like
11:45 - 11:48not you want you want it you want to be confident and in the way you look
11:48 - 11:48with these right?
11:49 - 11:52You want to be able to go right into the position and know
11:52 - 11:55whether or not you've loaded this
11:55 - 11:58nerve and that takes just a little bit of practice. If you
11:58 - 12:01guys have any questions leave it in the comments box below. I look
12:01 - 12:01forward to hearing from you.

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