Upper limb tension tests
ULTTS
A-ULTT1
B-ULTT2a
C-ULTT2b
D-ULTT3
First:Some rules
-Shoulder depression cause stretch on all roots of brachial plexus from C7 to T1..so it maintain tension on them
-Shoulder abduction stretches on C5, C6, C7
-External rotation : Increase also tension on all roots of brachial plexus
-Elbow extension tighten median nerve and radial nerve…But it cause loosening of ulnar nerve
While flexion of elbow causes opposite effect
-Wrist Extension tighten median and ulnar nerves…But it causes loosening of radial nerve
And opposite occurs with wrist flexion
-Lateral neck flexion on opposite side to tested side causes increase tension on roots…but to same side it decrease tension
Precaution:-Once obtain a component of test,…It must be maintained till end of the test to give more tension in addition to the following component
Tension tests
A-ULTT1
It is median nerve dominant utilizing shoulder abduction
-Application:-
-Patient is supine lying with shoulder abducted and fore arm pronated…And therapist faces axilla of patient
-Stage1:Apply shoulder depression passively
-Stage2:Supinate fore arm fully
-Stage 3 : Extend wrist and fingers
-Stage3:External rotation
-Stage4: Elbow extension
-Stage5:Lateral flexion of head away from tested side
-Indications:-
-All upper limb disorders
-All neck disorders
-All thoracic disorders
-All head disorders
It is preferred that elbow extension applied as last component of test as it cause high tension and may cause injury
Should be care full as nerves of upper limb are more sensitive than those of lower …so they are liable to be injured
-Responses of normal people:-
-Stretch in the anticubital area(anterior to cubital fossa)in about 99% of people,, and on lateral aspect of forearm down to hand in about 80% of people
-Tingling and burning sensation at lateral 3.5 fingers in course of median nerve
-Small percentage feel pain area anterior to shoulder
-Lateral neck flexion away from tested side increase symptoms….
-Variations and sensitization:-
-Causing elbow extension to be last component.
-making same test components but in opposite sequence
-Shoulder flexion____Decrease symptoms
-Shoulder extension___Increase symptoms
-some prefer application of external rotation before supination
-Lateral flexion of neck to wards tested part___ decrease symptoms((Lateral neck flexion can be used as initial examination of test ))
-Application of the test on both upper limbs on same time
-Contra lateral or epsilateral straight leg raising in same time of test application
-Patient with irritable disorders begin the exercise with the with neck flexion to wards tested side
B-ULTT2a
Median nerve bias using shoulder depression and external rotation
-Application:-
-stage1 :Patient is lying supine oblique on bed so that scapula of tested limb is out side plinth
-Stage2 :Head is neutral , then elbow flexion 90 degrees…And no abduction…and therapist stands at space between head and shoulder
-Stage 3 : Therapist carries patient fore arm and holding his elbow by one hand…other hand holding wrist.. and make passive shoulder depression by pushing by his thigh on patient shoulder …
-Stage 4:Then make passive abduction of shoulder 10 degrees…then extend elbow
-Stage5:Externally rotate shoulder
-Stage6:Extend wrist and fingers with shoulder abducted 50 degrees
-Indications:-
-Same previous (ULTT1)
-Responses of normal person:-
-No standard of it so it is not known
-But always apply test to both sides and compare them
-Variations:-
-Shoulder protraction :Causes increase tension on supra scapular nerve….cause pain along its site of supply
-Shoulder retraction: causes tension on long thoracic nerve
C-ULTT2b
-Radial nerve bias …Utilize shoulder depression and internal rotation
-Application:-
-Starting position is same as previous test:Patient is lying supine oblique on bed so that scapula of tested limb is out side plinth
Head is neutral , And no abduction…and therapist stands at space between head and shoulder
Therapist carries patient fore arm and holding his elbow by one hand…other hand holding wrist..
-Stage1: Make passive shoulder depression by pushing by therapist thigh on patient shoulder …
Then extend elbow ….And make passive abduction of shoulder 10 degrees…
-Stage 2 :Full medial rotation of shoulder
-Stage3:wrist flexion
-Stage4 :Fingers flexion with ulnar deviation
-Responses in normal:-
-Tension…tingling…burning on distribution of radial nerve at lateral side of forearm and dorsum of hand.
-Indication:-
-Same previous…In addition:-
-Tennis elbow(lateral epicondylitis)
-Dequervain disease : Inflammation of tendons of abductor pollicis brevis due to friction with tubercle of scaphoid
-Variations and sensitization:-
-Shoulder protraction or retraction
-Shoulder abduction
-Wrist radial deviation
-Supination
-Lateral flexion of head to wards or away from tested side
-Same test from prone lying
-Same tension test but reverse sequence
-ULTT3
Ulnar nerve dominant utilizing elbow flexion and shoulder abduction
-Application:-
Patient is supine lying with fore arm pronated …And therapist faces axilla of patient
-Stage1:Elbow extended and forearm supinated
-Stage2:full elbow flexion
-Stage3:extend wrist and fingers…then Lateral rotation
-Stage4 : Scapular depression and down ward movement to lock scapula
-Stage 5:full Abduction of shoulder
-Stage5: Lateral head flexion away from tested side
-Responses in normal:-
-Tension , tingling…..In course of ulnar nerve
-Indications:-
-Same previous..In addition:-
-Gulfers elbow ((medial epicondylitis))
-corpal tunnel syndrome
-Although this test is ulnar nerve bias…but it can be used to test for corpal tunnel syndrome which is median neuropathy
سكشن ثرابيوتك اكسرسيز
دكتوره سهير
30/10/2007
أسماء..
موضوع: سكشن ثرابيوتك اكسرسيز..upper limb tension tests 
الجمعة نوفمبر 02, 2007 12:33 am
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