Shoulder Orthopaedic Test: Upper Limb Tension Tests (ULTTs) - 3

The Upper Limb Tension Test 3 (ULTT3) is used to assess for nerve irritation or compression in the upper limb, specifically the ulnar nerve.

Here is the step-by-step procedure for ULTT3:

1. The patient lies supine on a table with the shoulder abducted to 90 degrees and the elbow flexed to 90 degrees.
2. The examiner stands at the patient's side and passively abducts the patient's shoulder to 110-120 degrees, externally rotates the arm, and extends the elbow.
3. The examiner then supinates the patient's forearm and extends the wrist while maintaining elbow extension.
4. The examiner then applies an overpressure force to the wrist in the direction of flexion and adduction.
5. The test is considered positive if the patient experiences pain, paresthesia, or other symptoms in the median nerve distribution (palmar aspect of the thumb, index, and middle fingers) during the test.

If the patient experiences pain or discomfort in the ulnar nerve distribution during the test, this may indicate nerve irritation or compression in the ulnar nerve. However, it is important to note that the ULTT3 should be used in conjunction with other examination techniques and diagnostic tests to accurately diagnose nerve injuries.

References:

1. Elvey RL. The investigation of arm pain. In: Butterworths, editor. Clinical Neurodynamics: A New System of Neuromusculoskeletal Treatment. Oxford: Butterworth-Heinemann; 1980. p. 147-212.
2. Cleland JA, Childs JD, McRae M, Palmer JA, Stowell T. Immediate effects of thoracic manipulation in patients with neck pain: a randomized clinical trial. Man Ther. 2005;10(2):127-135. doi:10.1016/j.math.2004.08.005
3. Kim JH, Kwak DS, Lee HJ, Kim TH, Lee MY, Lee DH. The Reliability and Validity of the Upper Limb Neurodynamic Test 3 in Patients With Cervicobrachial Pain Syndrome. Ann Rehabil Med. 2017;41(1):116-122. doi:10.5535/arm.2017.41.1.116