Indications

Upper Limb Tension test is a cervical spine examination procedure that tests for radiculopathy, IVF incroachment and SOL. Elvey’s Test is another name for Upper Limb Tension test.

Procedure

Patient should be awake and cooperative to perform the Upper Limb Tension test.

  1. Patient should be supine with shoulders in depressed position (it is crucial that the shoulders remain depressed through the entire testing procedure). Cervical spine should be laterally flexed away from the side being examined.
  2. During each of the maneuvers, the examiner slowly moves the arm towards the appropriate end range position noting the presence of neurologic and local musculoskeletal signs and symptoms.
  3. As the elbow approaches end range motion symptom are most often noted (flexion will stress the ulnar nerve and extension stresses the median and radial nerves). Therefore, flexion and extension of the elbow should be the last action of each maneuver.

ULTT1: Shoulder depressed and abducted 110 degrees, elbow, wrist, and fingers extended, forearm supinated (median nerve tension).

ULTT2: Shoulder depressed, externally rotated and abducted 10 degrees, elbow, wrist and fingers extended, forearm supinated (median, musculocutaneous, axillary nerve tension).

ULTT3: Shoulder depressed, internally rotated and abducted 10 degrees, elbow extended, forearm pronated, wrist flexed and deviated towards ulna, fingers flexed (radial nerve tension).

ULTT4: Shoulder depressed, externally rotated and abducted 90 degrees (patient’s hand should approximate ipsilateral ear), elbow flexed, forearms supinated, wrist extended and deviated towards the radius, fingers extended (ulnar nerve tension).

Examiner moves the arm towards the end range position.

Interpretation

Positive Upper Limb Tension Test

There is positive Upper Limb Tension test when there is arm pain or reproduction of neurologic symptoms. This could indicate radiculopathy, IVF encroachment or SOL.

Clinical Notes

The non-symptomatic side should be tested before the symptomatic side. Tests are similar to SLR in the lower extremity.

Clinician’s option: To further increase nerve tension, the examiner may instruct the patient to rotate head away, flex the neck and take a deep breath.  All these will be able to increase nerve root or brachial plexus tension.