This document describes three upper limb tension tests (ULTT1, ULTT2, ULTT3) used to assess the cervical spine and brachial plexus. ULTT1 involves abducting, supinating, and laterally rotating the shoulder while extending the elbow and wrist. ULTT2 adds shoulder depression while extending the elbow and laterally rotating the arm. ULTT3 (ulnar nerve bias) assesses the cubital tunnel by having the patient flex their elbow while the examiner controls their hand and arm. Precautions are described and variations discussed, including assessing different angles of abduction. The tests aim to isolate tensions and identify symptoms to determine involved structures.

1. UPPER LIMB TENSION TEST
Dr Ankit Pachori
P.G Dept. of physiotherapy

3. ULTT 1 METHOD
The examiner faces
the patient in stride standing, his right
hand holding her left hand ensuring
control rightdown to the thumb and
finger tips. Her upper arm rests on me
examiner's left thigh

4. • The patient's arm is subsequently abducted
in lhe coronal plane to approximately 110",
Greater control and support of the arm can
be achieved if the abduction component is
performed with the patient's arm resting on
the physiotherapist's thigh. In this way, the
physiotherapist can walk the arm up into
abduction whilst maintaining complete
support and control o f the movement

5. • With this position
maintained, the forearm
is supinated and the wrist
and fingers extended.
• The shoulder is laterally
rotated.
• The elbow is
extended,Earlier
component positions
must be strictly
maintained.

6. • With this position held,
cervical lateral flexion to the
left and then to the right arc
added. 'Keep looking at the
ceiling and take your car to
your shoulder' is a useful
command.

7. • The most important pan of the test, and
indeed of any tension test, is that once pan o f
the rest has been taken up. these positions
must be firmly maintained before the addition
of the next component. Symptoms and
symptom changes must be identified and
interpreted after each step.

8. • All alternative method of
handling
• In the second stage,
rather than maintaining
the shoulder girdle
depression by the
examiner's fist on the
bed. the physiotherapist
can place his left elbow
on the patient's shoulder
girdle with his forearm
along her upper ann.

9. Precautions

11. Variation
• Bilateral ULTT1.
• ULTTI + BILATERAL SLR
• ULTT1 in diff positions
of ABD(70,110,130,170)
• 110: optimal for C5,6,7

12. ULTT2

13. • Using his thigh, the examiner
carefully depresses the
patient's shoulder girdle.
• Quite a sensitive feel can be
developed with the thigh and
the obvious advantage is that
the depression can be
maintained, leaving two hands
free (or movement
combinations of the rest of the
arm. The test will have to be
performed in approximately
10° of shoulder abduction so
that the arm is clear and
parallel to the side of me bed.

14. • The shoulder depression
is maintained and then
the examiner
subsequently extends the
patient's elbow.
• The shoulder girdle
depression/elbow
extension position is
maintained and the
examiner, using both
arms; laterally rotates the
patient‘s whole arm

15. • With this position
maintained, the examiner's
left forarm is pronated and
slides down to the patient's
hand. The examiner's
thumb is slipped in the web
space between the patient's
thumb and index finger. The
examiner then extends the
patient's wrist, fingers and
thumb. This position
provides good control over
the arm, including the tips
of the fingers

16. • The most common
sensitising addition is
abduction of the
shoulder

21. ULTT 3 (ULNAR NERVE BIAS)
• Method
• The patient and the physiotherapist are in me
same starring position as for ULTT. Note the
stride standing position of the physiotherapist,
such that the body can be used to make the
test a smooth flowing action with minimal
foot movements. The patient'S elbow is rested
just below the anterior superior iliac spine, in
the examiner's left groin

24. • ELBOW FLEXION TEST:
• Cubital tunnel
syndrome.