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Upper Limb Tension Tests (ULTT)

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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.

All Tests:

  • Tests are performed in the supine position and resting symptoms are assessed.
  • Tests begin with depression and stabilization of the scapula and reassessment of resting symptoms (17).

Median Nerve Bias

  1. Shoulder Abducted to 110º
  2. Forearm supinated
  3. Wrist extended and ulnar deviated, fingers extended
  4. Elbow extended

Ulnar Nerve Bias

  1. Shoulder Abducted to 110º and externally rotated to 90°
  2. Forearm pronated
  3. Wrist extended and ulnar deviated, fingers extended
  4. Elbow flexed

Radial Nerve Bias

  1. The arm starts by the side
  2. Fingers are flexed over a flexed thumb
  3. Wrist flexion and radial deviation
  4. Elbow remains in extension
  5. Shoulder internally rotated and abducted 10° or more

All Tests:

  • Tests are positive if there is a considerable restriction in extensibility and radiated symptoms
  • Sides should be compared.
  • Tests may be sensitized by adding cervical lateral flexion:
    • If symptoms increase with contralateral cervical flexion; more indicative of cervical radiculopathy.
    • If symptoms decrease with ipsilateral cervical flexion; more indicative of cervical radiculopathy.

Note: Every text I referenced had a different set of instructions for these tests, including different joint actions, different order of steps, and different numbering/titling of the various nerve biases. For this reason, the tests were named by the nerve being tensioned, steps were ordered based on common practice, and only tests referenced in the research were used. The order of steps likely matters less if symptoms are reassessed with each step.

Test for:

Upper extremity neuritis and nerve root involvement (1- 3, 4, 6, 12, 15, 16 - 19)

Not accurate for the diagnosis of carpal tunnel syndrome
Action: Increase tension on the brachial plexus and nerves of the upper extremity.
Statistics: Better sensitivity than specificity (6, 12). These tests are indicative of nerve involvement, but several impairments may involve nerve irritation, resulting in a relatively low specificity.
Best use:

May be useful as a screen - By definition, the diagnosis of radiculopathy involves nerve root symptoms. Considering the sensitivity of this test for detecting nerve irritation, a negative on this test may rule out radiculopathy as a likely diagnosis.

This may suggest this test is useful as a screen (19); however, use in a cluster is still recommended.
Included in Clusters: Wainner's Clinical Prediction Rule for Cervical Radiculopathy

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