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Elvey Test | Upper Limb Tension Tests (ULTTs) Overview 2024

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Elvey Test | Upper Limb Tension Tests (ULTTs)

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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. It was first described by Elvey RL.

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, is divided into four tests. Modification of the position of the shoulder, elbow, forearm, wrist, and fingers places greater stress on specific nerves (nerve bias). Each test begins by testing the good side first and positioning the shoulder, followed by the forearm, wrist, fingers, and last, because of its large ROM, the elbow.

  • 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 1
ULTT 1 (Median nerve)

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 2
ULTT 2 (Musculocutaneous, Axillary nerves)

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 3
ULTT 3 (Radial nerve)

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

Upper Limb Neurodynamic (Tension) Tests Showing Order of Joint Positioning and Nerve Bias:

ULTT 1ULTT 2ULTT 3ULTT 4
ShoulderDepression and abduction (110°) Depression and abduction (10°) Depression, shoulder medial rotation, abduction (40°), and extension (25°) Depression and abduction (10° to 90°), hand to ear
ElbowExtension Extension Extension Flexion
ForearmSupination Supination Pronation Supination or pronation
WristExtensionExtensionFlexion and ulnar deviationExtension and radial deviation
Fingers and thumbExtension Extension FlexionExtension
Shoulder Lateral rotationMedial rotationLateral rotation
Cervical spineContralateral side flexionContralateral side flexionContralateral side flexionContralateral side flexion
Nerve biasMedian nerve, anterior interosseous nerve, C5, C6, C7Median nerve, musculocutaneous nerve, axillary nerveRadial nerveUlnar nerve, C8 and T1 nerve roots
The elbow motion is often done last as the elbow ROM increase or decrease can be used to determine whether the patient is improving or regressing over time.

Evans described a modification of the Elvey Test that he called the brachial plexus tension test. The sitting patient abducts the arms with the elbows extended, stopping just short of the onset of symptoms. The patient laterally rotates the shoulder just short of symptoms, and the examiner then holds this position. Finally, the patient flexes the elbows so that the hands lie behind the head. Reproduction of radicular symptoms with elbow flexion is considered a positive test. This test is similar to ULTT4 and stresses primarily the ulnar nerve and the C8 and T1 nerve roots.

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).
  • Davis et al. felt the tests should be considered positive only if neurological symptoms were manifested before 60° of elbow extension when elbow extension was the last movement performed

Sensitivity & Specificity

A systematic review 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 & More

  1. Elvey RL. The investigation of arm pain. In: Boyling JD, Palastanga N, eds. Grieve’s Modern Manual Therapy: the Vertebral Column. 2nd ed. Edinburgh: Churchill Livingstone; 1994.
  2. 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. Pubmed
  3. 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.
  4. Davis DS, Anderson IB, Carson MG, et al. Upper limb neural tension and seated slump tests: the false positive rate among healthy young adults without cervical or lumbar symptoms. J Man Manip Ther. 2008;16:136–141. Pubmed
  5. 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.
  6. Clinical Tests for the Musculoskeletal System 3rd Edition.
  7. Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.
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