Upper Limb Tension (neurodynamic) Test 3 – Ulnar Nerve and C8, T1 Nerve Root Bias

Purpose of Upper Limb Tension Test 3: To determine if the tension along the ulnar nerve and C8, T1 nerve roots contribute to neurologic symptoms associated with cervical radiculopathy.

Patient position: Supine lying.

Examiner position: Standing beside the examination table, facing the patient, at the side of the limb to be tested.

Procedure: Perform the joint positioning sequence in the following order:

1. Shoulder girdle/Scapular depression (with the examiner’s one hand around the patient’s wrist and the other hand wrapping/cupping/stabilizing patient’s shoulder girdle from underneath),
2. Shoulder external rotation, abduction, and elbow flexion up to 90 degrees,
3. Forearm pronation,
4. Wrist extension and radial deviation,
5. Fingers and thumb extension,
6. Elbow flexion (with the 4^th and 5^th fingers reaching towards the root of the neck),
7. Shoulder abduction (using the examiner’s thigh closer to the patient),
8. Sensitizing position: Contralateral or Ipsilateral cervical spine lateral flexion.

Outcome: This test is positive if (a) the limb/joint positioning sequence reproduces symptoms associated with radiculopathy, (b) the sensitizing position reproduces symptoms, and (c) there is a repeatable and measurable asymmetry between both sides along with the reproduction of symptoms. 

Reference:

1. Kleinrensink GJ, Stoeckart R, Mulder PG, Hoek G, Broek T, Vleeming A, et al. Upper limb tension tests as tools in the diagnosis of nerve and plexus lesions. Anatomical and biomechanical aspects. Clinical biomechanics (Bristol, Avon). 2000;15(1):9-14.
2. Petersen SM, Covill LG. Reliability of the radial and ulnar nerve biased upper extremity neural tissue provocation tests. Physiotherapy Theory and Practice. 2010;26(7):476-82.