Shoulder Orthopaedic Test: Upper Limb Tension Tests (ULTTs) - 2a

Upper Limb Tension Tests (ULTTs) - 2a, also known as the Median Nerve Tension Test or the Elbow Flexion Test, is a physical examination technique used to assess the presence of median nerve involvement in the arm or hand. This test involves the passive movement of the upper extremity, which places tension on the median nerve.

Here are the steps to perform ULTTs 2a:

1. The patient is asked to sit or lie down in a comfortable position.
2. The examiner stands beside the patient and lifts the affected arm, keeping the shoulder and elbow straight and the wrist extended.
3. The examiner then moves the patient's arm laterally (away from the body) to the point of pain or resistance.
4. Once the end range is reached, the examiner asks the patient to flex their elbow and extend their wrist.
5. The examiner then releases the wrist extension and elbow flexion, while maintaining the lateral movement of the arm.
6. The test is positive if the patient experiences pain or paresthesia in the median nerve distribution (thumb, index, middle, and half of the ring finger).

The interpretation of the ULTTs - 2a is based on the reproduction of the patient's symptoms and the amount of movement restriction or pain during the test. A normal result is the absence of reproduction of the patient's symptoms and no pain or discomfort during the test. The sensitivity and specificity of ULTTs - 2a depend on the underlying condition being tested for and are not well-established for this specific test.

References:

1. Butler, D. S. (2000). The sensitive nervous system. Noigroup Publications.
2. Cleland, J. A., Koppenhaver, S., & Netter, F. H. (2010). Netter's orthopaedic clinical examination: an evidence-based approach. Elsevier Health Sciences.
3. Coppieters, M. W., Alshami, A. M., & Babri, A. S. (2007). Souvlis T, Kippers V, Hodges PW. Strain and excursion of the sciatic, tibial and plantar nerves during a modified straight leg raising test. J Orthop Res, 25(2), 192-200.
4. De-la-Llave-Rincón, A. I., Fernández-de-las-Peñas, C., Palacios-Ceña, M., Cleland, J. A., & Ortega-Santiago, R. (2012). Bilateral sensory abnormalities in patients with unilateral carpal tunnel syndrome. Archives of physical medicine and rehabilitation, 93(12), 2267-2272.
5. Vicenzino, B., Wright, A., & Cleland, J. A. (2005). The use of an immediate external rotation force to normalize pain and range of motion in a shoulder with frozen shoulder symptoms–a case report. Manual therapy, 10(3), 230-235.