Upper Limb Tension Test | Upper Limb Nerve Entrapment

The Upper Limb Tension Test  or Median Nerve Bias Test is a clinical test to assess the mechanical provocation and range of motion of the median nerve. The upper limb tension test is one among the other tests that evaluates the reaction of the neural tissue to tension, stretch, and sometimes—even compression.

Indication for the Upper Limb Tension Test

ULTT A is indicated for patients who present with symptoms suggestive of median nerve irritation or entrapment, such as: ULTT  is indicated for patients who present with symptoms suggestive of median nerve irritation or entrapment, such as:

• Neck pain that shoots down the arm.
• Tingling
• numbness, or burning of the thumb
• index, and middle fingers.
• Soreness or burning sensation of the tissues supplied by the affected median nerve.
• Recurrent daily use of the upper limbs.

How to Perform Upper Limb Tension Test

1. Patient Position: The position of the limb is strictly standard where the patient is required to have the arm down on the examination table and not flexed.
2. Hand Placement: The following positions are kept by the physiotherapist during the treatment: the physiotherapist being positioned beside the patient; and the physiotherapist facing the patient’s head.
3. Scapular Depression: They make a fist and place it over the patient’s shoulder girdle, putting their thumb on top and the other fingers inside.
4. Shoulder Abduction: The physiotherapist lifts the patient above their head to about ninety degrees.
5. Forearm Supination: As for the supination test, the physiotherapist places the patient’s forearm in the supinated position.
6. Wrist and Finger Extension: The physiotherapist bring forward the patient’s wrist and fingers.
7. Elbow Extension: The patient’s position is relocated by the physiotherapist and the latter proceeds to slowly move the patient’s elbow.
8. Head Movements: The patient can also be directed towards tilting the head to one side and then the other in order to test the response of the shoulder of the contralateral limb.
9. Observation: The patient is then positioned in a sitting position from the supine position, and the physiotherapist notes for reproduction of symptoms, resistance or discomfort.

Assessment Outcome of Upper Limb Tension Test 

• Positive Test: The patient has reproduction of the symptoms like tingling, numbness or pain along the median nerve in distribution suggesting median nerve tension of entrapment.
• Negative Test: There no symptom reproduction and the patient feels comfortable, it can indicate the low median nerve tension and its entrapment.

Differential Diagnosis with Upper Limb Tension Test

ULTT A is useful for differentiating median nerve irritation or entrapment from other conditions, such as:

• Cervical radiculopathy.
• Carpal tunnel syndrome.
• Thoracic outlet syndrome.
• Brachial plexus injury.
• Tendonitis or tenosynovitis.
• Shoulder or arm musculoskeletal type of pain.

Related Tests of Upper Limb Tension Test 

• Based on the previous exposure to ULTT diagrams, this is the ULTT B (Radial Nerve Bias).
• Finally, in ULTT C (Ulnar Nerve Bias),it involves ulnar sensory nerve that innervates medial aspect of the dorsum of hand and regulates sensation of the tips of the thumb, index, middle, ring and small fingers.
• The orthopedic test includes; Spurling’s Test, also known as cervical radiculopathy test.
• Tests such as Phalen’s test that focuses on the diagnosis of carpal tunnel syndrome.
• Positive Tinel sign is the phenomenon manifested when a nerve is irritated at a particular location such that it does not perform several tasks as it normally does when stimulated at another location.
• Theron’s Test / Roos Test (thoracic outlet syndrome)
   

Evidence-Based Physiotherapy

The evidence-based research therefore correlates with the use of ULTT A as a component of the overall evaluative plan for median nerve irritation/entrapment. Therefore, this test integrated with other clinical assessments and diagnostic procedures including nerve conduction tests or EMG provides efficient diagnosis.

Possible future research in physiotherapy could address the enhancement of diagnostic procedures, including new imaging technologies, as well as the strategies applied to manage NMJ disorders. In particular, the patients should undergo nerve gliding exercises, use ergonomics, manual therapy, and receive proper information on activity modification and prevention tactics.

Research that is currently available indicates that a reduction to referrals of patients with nerve entrapment syndrome symptoms may be improved by a method of intervention consisting of physiotherapy in the early stages of the disease. There is some literature on structured physiotherapy programs to reduce the symptoms and to avoid further relapse. In cases where the patient does not seem to recover from the condition or has severe symptoms, surgical options will be eligible.