Elvey Test

Elvey test (also known as upper limb tension tests ULTT or brachioplexus tension test) is a neurodynamic test used mainly to check for cervical spine radiculopathy.

The nerve roots supplying the upper extremity are provoked by stretching them utilizing position changes of the shoulder, elbow, and wrist.

How do you do the ULTT?

The upper limb tension test (ULTT Test), or brachial plexus tension tests, involve an ordered sequence of movement of the shoulder girdle, arm, elbow, forearm, wrist, and hand.

• The patient lies supine.
• During all the tests the examiner flexes the shoulder in a proximal anterior position with one hand while using the other hand to guide the patient’s arm to the set positions.
• Care must be taken to maintain the cervical spine in neutral flexion–extension, side bending, and rotation.
• All the tests is repeated on the contralateral extremity and the results are compared

See Also: Brachial Plexus Anatomy

The ULTTs as described by Elvey are divided into four examination segments:

Elvey Test 1 (Median nerve):

• The examiner depresses the shoulder girdle, abducts the humerus to 110°, extends the elbow, supinates the forearm, extends the wrist, and extends the fingers and thumb.
• The sensitizers for this test are cervical spine side flexions either toward or away from the involved side.

Several studies have shown that the longitudinal motion of the median nerve is affected by motion of the fingers and wrist, with digital flexion resulting in a proximal slide into the forearm, and wrist and finger extension both producing a distal slide of the nerve toward the hand. Hyperextension of the wrist has been shown to cause the median nerve to slide 10–15 mm distally relative to a fixed bony landmark in the carpal tunnel whereas flexion of the wrist and fingers moves the nerve 4 mm proximally.

Elvey Test 2 (Musculocutaneous, Axillary nerves):

• The examiner places the shoulder at 10° abduction, extends the elbow, supinates the forearm, and extends the wrist, fingers, and thumb. From this position, the shoulder is externally rotated.
• For the Axillary nerve the shoulder is abducted to approximately 40 degrees.

Elvey Test 3 (Radial nerve):

• Starting position: depresses, abducts (10°), and internally rotates the shoulder, elbow extension, forearm pronation, wrist flexion and ulnar deviation, finger and thumb flexion. The examiner internally rotates the arm.
• The sensitizers for this test are cervical spine side flexions either toward or away from the involved side.

Elvey Test 4 (Ulnar nerve, C8 and T1 nerve roots):

• The examiner successively abducts the shoulder from 10 to 90° and guides the hand toward the ear with the elbow maximally flexed and the forearm supinated. The wrist is extended and radially abducted, the fingers and thumb extended. The shoulder is externally rotated.
• The sensitizers for this test are side flexion of the head and neck, both toward and away from the test side.

What does positive ULTT mean?

• The elvey test causes narrowing of the intervertebral foramina.
• Radicular pains already present are worsened by these movement patterns.
• The occurrence of localized pains in the cervical spine without radicular symptoms suggests facet irritation.
• Pain on the convex side of the cervical spine indicates muscle dysfunction (of the sternocleidomastoid muscle, for instance).

Sensitivity & Specificity

A systematic review 1 of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy found that the upper limb tension test (ULTT test) demonstrated high sensitivity and low specificity ranging from:

• Sensitivity: 72-83 %
• Specificity: 11-33 %

Notes

• The Elvey tests for the cervical spine are equivalent to the Lasègue test for the lumbar spine.
• This test not only gives an indication as to the cause of pain but also demonstrates the success of treatment (with manual therapy measures, for example).

See Also: Lasègue test

Reference

1. Sidney M. Rubinstein,corresponding author Jan J. M. Pool,1 Maurits W. van Tulder, Ingrid I. Riphagen, and Henrica C. W. de Vet. A systematic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy.Eur Spine J. 2007 Mar; 16(3): 307–319. PMID: 17013656.
2. Elvey RL: Brachial plexus tension tests and the pathoanatomical origin of arm pain. In: Glasgow EF, Twomey LT, eds. Aspects of Manipulative Therapy. Melbourne, Victoria: Australia, Lincoln Institute of Health Sciences, 1979:105–110.
3. Kenneally M, Rubenach H, Elvey R: The upper limb tension test: the SLR of the arm. In: Grant R, ed. Physical Therapy of the Cervical and Thoracic Spine. New York, NY: Churchill Livingstone, 1988. INTERVENTION 420.
4. Clinical Tests for the Musculoskeletal System 3rd Edition.
5. Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.