Upper Limb Tension Test Research Articles

Validity of five common manual neck pain provoking tests

The purpose of the present study was to assess five manual tests for pain provocation of the neck to determine their suitability for epidemiological investigations. To 75 randomly selected men, five manual pain-provoking tests were applied in a single-blind design. Prevalence of reported neck dysfunction, sensitivity, specificity, and positive and negative predicted value for each test were calculated. 22 of the 75 reported present neck pain, while the remainder reported freedom from neck pain for at least one year. Palpation over the facet joints in the cervical spine was found to be the most appropriate screening test to corroborate the replies in self-reported questionnaires on dysfunctions of the neck. The outcome of this test was quite consistent with the reported neck pain. The test of the formina intervertebralia and the upper limb tension test caused pain in almost all subjects with reported neck dysfunctions, though not causing referred pain in the arm as an indication of neurogenous tissue origin, as it was aimed to. Neither the neck rotation test nor the active flexion/extension test was sufficiently provocative to confirm the reported neck pain in these subjects, as both were insufficiently sensitive.

Effect of the Upper Limb Tension Test 1 on conduction characteristics of median nerve in different sensitizers

Background and purpose: The neural tension test is used for examination and management of upper quadrant disorders. In spite of its extensive usage and recognition in clinical practice, controversies about neurophysiological basis for sensory and motor responses to test persist. Further, the test also lacks validity. Mechanosensitivity and conduction characteristics are key issues in neural problems. The purpose of the present study is to investigate the sensitive position in ULTT1 that subjects the median nerve to excessive stress, which may increase the mechanosenstivity and conduction velocity of the nerve, which in turn will help clinically to select the particular sensitizer for the neural mobilization treatment program for effective recovery. Methodology: A total of 50 subjects aged 17-25 years were selected by convenient sampling from Lovely Professional University, India. Upper limb tension test-1 was performed on dominant side maintaining ipsilateral neck side flexion and the corresponding MNCV values were recorded using the Medicaid EMG and vice versa. Results: The data were analysed using Students‘t’ – test. Significant changes were noted in MNCV values on Contralateral neck side flexion (55.286 ± 4.174) when combined with ULTT-1compared to ipsilateral neck side flexion (51.907 ± 4.37). Conclusion: The findings of the study suggest that contralateral neck side flexion has a significant effect on conduction characteristics of median nerve during ULTT-1 than the ipsilateral neck side flexion.

Scientific study of the extent of transverse movement of the median nerve at the wrist during active wrist extension in static positions of the upper limb tension test one

Objective. Longitudinal glide of the median nerve is affected in typical entrapment neuropathies such as carpal tunnel syndrome. The upper limb tension test one (ULTT1) is used by clinicians to assess patients’ responses to passive movements that affect the median nerve. ULTT1 is thought to mainly assess the longitudinal glide of the median nerve; however, transverse glide of the nerve at the wrist may be a more sensitive measure of an entrapment neuropathy. Method. Sixteen wrists of four male and 11 female healthy volunteers were studied with ultrasound imaging in this small original study. Images were collected in eight different combinations of shoulder, elbow and forearm posture. In each posture the wrist was moved from full flexion to 30° of extension. Results Nerve excursion from full wrist flexion to 30° of extension was mainly in a radio-dorsal direction. It ranged from a minimum of 1.8 mm (SD ± 2.0 mm) up to 3.57 mm (SD ± 1.86 mm) of transverse movement, and 0.22 mm (SD ± 0.59 mm) of volar movement to 0.96 mm (SD ± 0.76 mm) of dorsal movement. In all eight of the positions tested, forearm supination led to greater transverse movement of the nerve at the wrist. Conclusions Transverse movement of the median nerve is most marked with forearm supination, irrespective of other changes in the kinetic chain. The nerve moves dorsally in all movements except when the forearm flexors are off-loaded in elbow extension and elbow flexion. These findings confirm the transverse movement of the median nerve at the wrist, during active wrist extension within positions of the ULTT, but that the shoulder and elbow position have little impact on the degree of movement.

A best-evidence review of diagnostic procedures for neck and low-back pain

This chapter aims to present an overview of the best available evidence on diagnostic procedures for neck and low-back pain. Relatively little is known about the accuracy of such procedures. Although most spinal conditions are benign and self-limiting, the real challenge to the clinician is to distinguish serious spinal pathology or nerve-root pain from non-specific neck and low-back pain. The use of valid procedures can assist the clinician in this aim. A search was conducted in PubMed to identify relevant systematic reviews and primary studies on diagnostic procedures for the neck and low back. A systematic review was included if at least two independent reviewers were used; a systematic procedure was followed for identifying the literature; and a methodological assessment was conducted. In the absence of systematic reviews, primary studies are reported. Systematic reviews were identified which evaluated evidence for diagnostic procedures in the following categories: history, physical examination, and special studies, including diagnostic imaging, diagnostic blocks, and facet and sacroiliac joint injections. In general, there is much more evidence on diagnostic procedures for the low back than there is for the neck. With regard to the history, a number of factors can be identified which can assist the clinician in identifying sciatica due to disc herniation or serious pathology. With regard to the physical examination, the straight-leg raise is the only sign consistently reported to be sensitive for sciatica due to disc herniation, but is limited by its low specificity. The diagnostic accuracy of other neurological signs and tests is unclear. Orthopaedic tests of the neck, such as Spurling's or the upper-limb tension test, are useful to rule a radiculopathy in or rule out, respectively. In patients 50 years of age or older, plain spinal radiography together with standard laboratory tests are highly accurate in identifying underlying systemic disease; however, plain spinal radiography is not a valuable tool for non-specific neck or low-back pain. There is strong evidence for the diagnostic accuracy of facet joint blocks in evaluating spinal pain, and moderate evidence for transforaminal epidural injections, as well as sacroiliac joint injections for diagnostic purposes. In conclusion, during the history, the clinician can accurately identify sciatica due to disc herniation, as well as serious pathology. There is sufficient evidence regarding the accuracy of specific tests for identifying sciatica or radiculopathy (such as the straight-leg raise) or certain orthopaedic tests of the neck. Plain spinal radiography in combination with standard laboratory tests is useful for identifying pathology, but is not advisable for non-specific neck or low-back pain.

A systematic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy

Clinical provocative tests of the neck, which position the neck and arm inorder to aggravate or relieve arm symptoms, are commonly used in clinical practice in patients with a suspected cervical radiculopathy. Their diagnostic accuracy, however, has never been examined in a systematic review. A comprehensive search was conducted in order to identify all possible studies fulfilling the inclusion criteria. A study was included if: (1) any provocative test of the neck for diagnosing cervical radiculopathy was identified; (2) any reference standard was used; (3) sensitivity and specificity were reported or could be (re-)calculated; and, (4) the publication was a full report. Two reviewers independently selected studies, and assessed methodological quality. Only six studies met the inclusion criteria, which evaluated five provocative tests. In general, Spurling's test demonstrated low to moderate sensitivity and high specificity, as did traction/neck distraction, and Valsalva's maneuver. The upper limb tension test (ULTT) demonstrated high sensitivity and low specificity, while the shoulder abduction test demonstrated low to moderate sensitivity and moderate to high specificity. Common methodological flaws included lack of an optimal reference standard, disease progression bias, spectrum bias, and review bias. Limitations include few primary studies, substantial heterogeneity, and numerous methodological flaws among the studies; therefore, a meta-analysis was not conducted. This review suggests that, when consistent with the history and other physical findings, a positive Spurling's, traction/neck distraction, and Valsalva's might be indicative of a cervical radiculopathy, while a negative ULTT might be used to rule it out. However, the lack of evidence precludes any firm conclusions regarding their diagnostic value, especially when used in primary care. More high quality studies are necessary in order to resolve this issue.

User's guide to the Chiropractic Literature-IB: how to use an article about therapy

User's guide to the Chiropractic Literature-IB: how to use an article about therapy

Characterisation of chronic lateral epicondylalgia using the McGill pain questionnaire, visual analog scales, and quantitative sensory tests

Abstract Aims: To characterise chronic lateral epicondylalgia using the McGill Pain Questionnaire, Visual Analog Scales for pain and function, and Quantitative Sensory Tests; and to examine the relationship between these tests in a population with chronic lateral epicondylalgia. Method: Fifty-six patients (29 female, 27 male) diagnosed with unilateral lateral epicondylalgia of 18.7 months (mean) duration (range 1-300), with a mean age of 50.7 years (range 27-73) participated in this study. Each participant underwent assessment with the McGill Pain Questionnaire (MPQ), Visual Analog Scales (VAS) for pain and function, and Quantitative Sensory Tests (QST) including thermal and pressure pain thresholds, pain free grip strength, and neuromeningeal tissue testing via the upper limb tension test 2b (ULTT 2b). Results: Moderate correlation (r = .338 - .514, p = .000 - .013) was found between all indices of the MPQ and VAS for pain experienced in the previous 24 hours and week. Thermal pain threshold was found to...

Effect of the Upper Limb Tension Test on the Conduction Characteristics of the Median Nerve

C E Daborn, R Stephenson, B Richardson University of East Anglia, Norwich Introduction Little evidence exists on the ability of the upper limb tension test (ULTT) to apply tension to a peripheral nerve in living subjects. Controversy surrounds the potential of such tests to provoke a protective muscle response and thus prevent any movement or stretch of the nerve. The aim of this study was to investigate the effects of applying a ULTT, with median nerve bias, on the conduction characteristics of the median nerve.

An investigation to compare the effectiveness of carpal bone mobilisation and neurodynamic mobilisation as methods of treatment for carpal tunnel syndrome

Carpal tunnel syndrome is the most common peripheral entrapment neuropathy. There is little literature available that addresses the management of this condition, which may partly explain why physiotherapy is often overlooked as a treatment approach in its management. This study investigated the effects of two manual therapy techniques in the treatment of patients experiencing carpal tunnel syndrome. An experimental different subject design compared three groups of subjects in three different conditions (two treatment interventions and one control group). Each group consisted of seven patients. The objectives of the study were: (1) to investigate differences between treated and untreated groups; (2) to investigate differences in the effectiveness of treatment I (median nerve mobilization) compared with treatment II (carpal bone mobilization). Measurements were taken applying several measurement tools, including active range of wrist movement (ROM flexion and extension), upper limb tension test with a median nerve bias (ULTT2a), three different scales to evaluate pain perception and function, and lastly numbers of patients continuing to surgery in each group were compared. In visual terms a clear trend was demonstrated between subjects who received treatment compared to those who were not treated, in particular the descriptive analysis of results for ULTT2a and numbers of patients continuing to surgery. When analysed statistically, less could be concluded. Only scores on a Pain Relief Scale (P<0.01) demonstrated highly significant differences between the three groups when analyzed using Kruskal–Wallis Test. In exploring the results of the two intervention groups, no statistically significant difference in effectiveness of treatment was demonstrated between carpal bone mobilization and median nerve mobilization.

A Single Blind Investigation into the Potential Differences in Passive Range of Movement at the Elbow, between Dominant and Non-dominant Arm, when Using the Upper Limb Tension Test 1

A Single Blind Investigation into the Potential Differences in Passive Range of Movement at the Elbow, between Dominant and Non-dominant Arm, when Using the Upper Limb Tension Test 1

Upper limb tension tests as tools in the diagnosis of nerve and plexus lesions: Anatomical and biomechanical aspects

Objective. To analyse the validity of nerve tension tests used in the diagnosis of nerve (root) and plexus lesions of the upper extremity. Design. In six arms of embalmed human bodies, in situ measurements were performed to assess the effect of nerve tension tests on the median, ulnar and radial nerves and the cords of the brachial plexus. Background. In clinical practice it is useful to have fast, easy and cheap tests for the diagnosis of nerve (root) lesions of the upper extremity, analogous to Lasègue’s Straight Leg Raising test. Methods. The Upper Limb Tension Tests for the median, ulnar and radial nerves, as well as the Upper Limb Tension Tests combined with contralateral rotation and lateral bend of the cervical spine (Upper Limb Tension Test+) were used to generate tension to these nerves. Buckle force transducers were used to assess tensile forces in the nerves and in the medial, lateral and posterior cords of the brachial plexus. Results. Nerve tension introduced in the distal part of the median, ulnar and radial nerves was transmitted upward to the cords of the brachial plexus. Exclusively the median nerve Upper Limb Tension Test and Upper Limb Tension Test+ turned out to be sensitive and specific tension tests. Mechanical tension caused by the Upper Limb Tension Test+ was not significantly higher than that caused by the Upper Limb Tension Tests. The Upper Limb Tension Tests cannot be used to selectively stress cervical nerve roots. The findings justify investigation of exclusively the median nerve Upper Limb Tension Test and Upper Limb Tension Test+ on their clinical validity. Relevance Before nerve tension tests for the median, ulnar and radial nerves can be introduced to clinical practice it is necessary to assess their validity quantitatively.

A qualitative assessment of shoulder girdle elevation during the upper limbtension test 1

The 'feel through range' and the 'end-feel' of the elbow extension, and the elevation of the shoulder girdle during the upper limb tension test for the median nerve are considered important in clinical decision making. As no objective measurements have been published regarding these parameters, a special device was designed in order to obtain objective information on the force by which the shoulder girdle is elevated during the test. The purpose of this technical note is to describe the technical aspects of the device and its practical application. In a pilot study, five asymptomatic subjects have been assessed. The relationship between the elevation of the shoulder girdle and the range of elbow extension has been analysed. The data of five subjects and representative curves of one subject are presented. All five subjects demonstrate a considerable increase in force elevating the shoulder girdle. The results show that the device can be used to measure the force by which the shoulder girdle is elevated throughout the test. Although the number of subjects and the number of repetitions is limited, the data suggest that the method is accurate and that the phenomenon of shoulder girdle elevation during the upper limb tension test in asymptomatic subjects is consistent.

Overuse syndromes of the upper limb and the upper limb tension test: a comparison between patients, asymptomatic keyboard workers and asymptomatic non-keyboard workers

SUMMARY. Overuse syndromes of the upper limb (OSUL), also known as repetitive strain injury (RSI) remains a contentious issue that affects a large number of keyboard workers. This research used the results of a modified upper limb tension test (ULTT) performed on three independent groups to look for any similarities or discrepancies between them. The subjects were all female aged between 25–40 years, with groups consisting of 12 OSUL patients, 20 asymptomatic keyboard users and 19 asymptomatic non-keyboard users. The ULTT was positive in 100% of the patient group supporting several hypotheses that state that the pathology of OSUL is neurogenic in origin. The results of the two asymptomatic control groups were predicted to be the same, however this was not found to be the case. Unrelated t-tests were used to analyse the data showing that the keyboard users had a significantly positive ULTT compared to non-keyboard users, which were viewed as a normal control group. This suggests that a subclinical pathological state exists in the keyboard user group. Various subclinical physiological changes caused by prolonged sitting and keyboard use are suggested as possible causes for these results. This research highlights the need for intervention in an office environment to prevent further cases of OSUL from developing.

Persistent Mechanical Allodynia Following Injury of the Hand: Treatment Through Mobilization of the Nervous System

Mechanical allodynia (MA) following hand injury is a well-documented clinical problem. The purpose of this pilot study was to examine the relationship between hand MA and the upper limb tension test (ULTT). The ULTT mechanically stresses the neural structures from the C5/6/7 neural foramina to the median nerve distally. This study examined 29 subjects with unilateral hand MA before and after a 2-week neural self-mobilization programme. There was a significant difference between the subjects' affected and unaffected sides when tested using the ULTT, both in reproduction of symptoms and in reduced range of motion of the ULTT. Following the self-mobilization program, there was an improvement in the range of the ULTT, and subjects reported a reduction in their symptoms. Complete recovery was not obtained in all cases. The results of this study suggest that the ULTT is a useful tool both in assessment and treatment of subjects with hand MA.

Anatomy of the cervical spine: implications for the upper limb tension test

A detailed investigation of the anatomy of the lower cervical nerves and associated structures was undertaken, as these structures would most likely be affected by any stresses generated in the nerves of the brachial plexus during the upper limb tension test (ULTT). The investigation used dissection of three adult human spines and histological sections of three cervical spines. The results support the hypothesis that the lower cervical nerves have a specialised anatomical arrangement which may protect them from forces generated in the upper limb and cervical spine by the ULTT. The fifth, sixth and seventh cervical nerves are securely attached to many structures as they emerge from the spinal cord to form the brachial plexus. Furthermore, the posterior longitudinal ligament anchors the nerve roots to the vertebral bodies and intervertebral discs. The results suggest that innervated structures other than neuromeningeal tissue may also need to be considered when evaluating a patient's positive ULTT response.

Validity of five common manual neck pain provoking tests

The purpose of the present study was to assess five manual tests for pain provocation of the neck to determine their suitability for epidemiological investigations. To 75 randomly selected men, five manual pain-provoking tests were applied in a single-blind design. Prevalence of reported neck dysfunction, sensitivity, specificity, and positive and negative predicted value for each test were calculated. 22 of the 75 reported present neck pain, while the remainder reported freedom from neck pain for at least one year. Palpation over the facet joints in the cervical spine was found to be the most appropriate screening test to corroborate the replies in self-reported questionnaires on dysfunctions of the neck. The outcome of this test was quite consistent with the reported neck pain. The test of the formina intervertebralia and the upper limb tension test caused pain in almost all subjects with reported neck dysfunctions, though not causing referred pain in the arm as an indication of neurogenous tissue origin, as it was aimed to. Neither the neck rotation test nor the active flexion/extension test was sufficiently provocative to confirm the reported neck pain in these subjects, as both were insufficiently sensitive.

Strain at the subclavian artery during the upper limb tension test

The manoeuvres of the upper limb tension test (ULTT) were described by Elvey (1983 and 1985) to identify the presence of a brachial plexus component in upper arm pain. A pilot study was undertaken to examine strain at the subclavian artery during the ULTT in two embalmed cadavers. Photographs of the artery segments were obtained at each step of the test and from these, strain scores were calculated. Results show that limb manoeuvres conducted with cervical contralateral lateral flexion produced more strain than with ipsilateral lateral flexion. Since cervical contralateral lateral flexion appears capable of increasing strain at the subclavian artery, further studies comparing strain at the artery with strain at cervical nerves are indicated.

The relationship between upper trapezius muscle length and upper quadrant neural tissue extensibility

The upper trapezius muscle and the nerves of the brachial plexus share common anatomical locations and orientations. Whether upper trapezius muscle length measurements could be influenced by upper quadrant neural tissue extensibility was the question investigated in this paper. Two groups of normal subjects were studied, one with lesser and one with greater upper quadrant neural extensibility, measured by the upper limb tension test. Results indicated that those with decreased neural extensibility had significantly less measured length of the upper trapezii. These results should direct clinicians to assess neural tissue extensibility prior to interpreting the results of length tests of the upper trapezius muscle.

The Upper Limb Tension Test: Inter-tester Reliability for Assessing the Onset of Passive Resistance R 1

The aim of this trial was to assess the inter-tester reliability of the Upper Limb Tension Test (ULTT). The onset of passive resistance (R1) of the left elbow was determined by four experienced manual therapists in a group of asymptomatic subjects. A recording of the degrees of elbow extension was obtained using a goniometer, having first positioned the upper extremity in a bracket maintaining 110 degrees of shoulder abduction and 10 degrees of shoulder extension. Each rater then moved the subjects' left shoulder into full external rotation and the forearm into full supination with the wrist and fingers in a neutral position. Data was collected four consecutive days. The data was analyzed by a two-way analysis of variance. The means of the readings among the four raters was found to be significantly different. It was concluded that the ULTT has a low inter-tester reliability when R1 is compared. Several suggestions are made for future research projects in this area.

Hand hypersensitivity and the upper limb tension test: Another angle

Hand hypersensitivity and the upper limb tension test: Another angle