Upper Limb Tension Test 4 for Ulnar Nerve Entrapment

The upper limb tension tests can be seen as the equivalent of the straight leg raise test for the neurological structures of the upper limbs.

According to Wainner et al. (2003), the ULTT4 or ULTT D it has a sensitivity of 72% and a specificity of 33% for the diagnosis of cervical radiculopathy. Apelby-Albrecht (2013) however, found a sensitivity of 71% with a better specificity of 87%. For every test, make sure to test the good side first.

ULTT4 or ULTTD is designed to stress the ulnar nerve as well as the nerve roots C8 and T1. To perform the test, depress the shoulder first and then bring the arm into 90° of abduction, extend the fingers and wrist and supinate the forearm. Then bring the patient’s hand to his ear. Like with the other tests, you can increase the stress with a contralateral lateroflexion.

Positive Outcome: The patient’s familiar arm symptoms like shooting pain or paresthesia are reproduced. Some authors score the test negative in case of a marked decrease of mobility (>10°)

If you are interested in the other Upper Limb Tension Tests, check out the links below:

• Upper Limb Tension Test 1 /ULNT A
• Upper Limb Tension Test 2 / ULNT B
• Upper Limb Tension Test 3 / ULNT C

Apelby-Albrecht M, Andersson L, Kleiva IW, Kvåle K, Skillgate E, Josephson A. Concordance of upper limb neurodynamic tests with medical examination and magnetic resonance imaging in patients with cervical radiculopathy: a diagnostic cohort study. Journal of manipulative and physiological therapeutics. 2013 Nov 1;36(9):626-32.

Wainner RS, Fritz JM, Irrgang JJ, Boninger ML, Delitto A, Allison S. Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy. Spine. 2003 Jan 1;28(1):52-62.