Upper Limb Tension Tests (ULTT): How to Check for Nerve Tension

The Upper Limb Tension Tests (ULTT) are a series of neurodynamic tests used to assess the peripheral nerves of the arm (Median, Radial, and Ulnar). Click the sections below for details on how to perform them.

1. Purpose

The primary purpose of the Upper Limb Tension Tests (also called Neurodynamic Tests) is to **test for** the mobility and sensitivity of the brachial plexus and the main peripheral nerves (Median, Radial, and Ulnar). They check for signs of neural compression, irritation, or reduced mobility (adverse neurodynamics).

2. How to Perform

The patient is positioned in supine. The general procedure is to apply sequential tension to a specific nerve and check for symptom reproduction. The steps must be done in order.

ULTT 1 (Median Nerve Bias)

1. Stabilize/depress the shoulder girdle.
2. Abduct the shoulder to 90-110 degrees.
3. Externally rotate the shoulder.
4. Extend the wrist and fingers.
5. Supinate the forearm.
6. Slowly extend the elbow (this is the final movement).
7. To sensitize: Add cervical contralateral (side) flexion.

ULTT 2 (Radial Nerve Bias)

1. Stabilize/depress the shoulder girdle.
2. Internally rotate the shoulder.
3. Abduct the shoulder to 10 degrees (arm by side).
4. Extend the elbow.
5. Flex the wrist and fingers (make a fist around thumb).
6. Ulnar deviate the wrist.
7. To sensitize: Add cervical contralateral (side) flexion.

ULTT 3 (Ulnar Nerve Bias)

1. Stabilize/depress the shoulder girdle.
2. Abduct the shoulder to 90 degrees (hand near patient's ear).
3. Externally rotate the shoulder.
4. Flex the elbow (this is the final movement).
5. Extend the wrist.
6. Pronate the forearm.
7. To sensitize: Add cervical contralateral (side) flexion.

(Note: There is also a ULTT 2 for the Median nerve, but these three are the most distinct and commonly used variations for the 3 main nerves).

3. Positive & Negative Sign

Positive Sign (Test is POSITIVE):
A positive test requires all of the following:

• Reproduction of the patient's familiar neurological symptoms (e.g., pain, tingling, numbness).
• A significant difference in range of motion or symptom response compared to the uninjured side.
• Symptoms are altered (worse or better) by sensitizing movements, such as side-bending the neck away from (worse) or toward (better) the tested side.

Negative Sign (Test is NEGATIVE):
A negative test is the absence of symptoms, or only a minor, non-painful "stretch" feeling that is equal on both sides.