Upper Limb Tension Test 3 (ULTT3)

The Upper Limb Tension Test 3 (ULTT3)—also referred to as ULNT3 or Elvey’s Test D—is a neurodynamic assessment designed to test the ulnar nerve and, to a lesser extent, the C8–T1 nerve roots.​​
It is one of the four main variations of the Upper Limb Tension Test (ULTT) series used to evaluate nerve mobility and sensitivity in the upper extremity.

How Is the Test Performed?

  • Client position: Supine, head supported, and arms by the side.​​

  • Therapist procedure:

    1. Depress the shoulder to prevent elevation and stabilize the scapula (important for isolating the neural pathway).​​

    2. Abduct the shoulder to approximately 90–110°.​

    3. Externally rotate the shoulder while maintaining scapular depression.​

    4. Flex the elbow fully (bringing the hand toward the head).​​

    5. Pronate the forearm (palm down).​

    6. Extend the wrist and fingers (often with emphasis on the ring and little finger).​

    7. Add shoulder abduction slightly more (up to 110–120°) to tension the nerve further if needed.​

    8. Neck side bending (structural differentiation):

      • Contralateral side bending (away from tested side) should increase symptoms.

      • Ipsilateral side bending (toward tested side) should reduce them—confirming neural involvement.​​

  • Positive test:

    • Reproduction of paresthesia, burning, tingling, or pain along the ulnar nerve distribution (elbow → forearm → ring/little fingers).​​

    • Limited range of motion or symptom asymmetry compared to the opposite side also supports neural tension findings.

Clinical Significance

  • ULTT3 targets the ulnar nerve and is useful for identifying ulnar neuropathy, cubital tunnel compression, or C8–T1 cervical radiculopathy.​

  • It is often used in combination with other ULTTs (ULTT1–3) to pinpoint which nerve pathway is affected.​

  • A positive test indicates neurodynamic dysfunction, meaning restricted nerve glide or heightened sensitivity due to mechanical irritation or entrapment.

Assessment

  • Use ULTT3 for clients reporting:

    • Neck, shoulder, elbow, or hand pain (especially 4th and 5th digits).

    • Tingling, numbness, or burning along the ulnar nerve.

    • Weakness in hand grip or dexterity.

  • Document:

    • The exact limb position when symptoms appeared.

    • The distribution, intensity, and type of sensation.

    • Comparisons with the unaffected limb.​

Treatment

  • If positive:

    • Avoid deep, compressive, or prolonged manual therapy over irritated neural pathways (ulnar groove, medial arm, cubital tunnel).

    • Focus on gentle myofascial release, scalene/pectoralis minor relaxation, and mobility restoration for adjacent tissues to improve the nerve’s environment.​

    • When appropriate and trained, use gentle nerve gliding (“flossing”) techniques to promote mechanosensitivity reduction and improve function.

    • Educate clients about posture, ergonomics, and nerve-protective positions, especially avoiding prolonged elbow flexion or pressure at the medial elbow.

Safety & Referral

  • Refer immediately if neurological symptoms worsen, persist, or lead to muscle weakness or sensory loss in the hand or forearm.

  • Avoid ULTT testing or stretching in acute inflammation, post-surgical conditions, or severe cervical nerve compromise.