Upper Limb Tension Test 1

The Upper Limb Tension Test 1 (ULTT1) is also known as the Median Nerve Tension Test or Elvey Test A.  ULTT1 is a neurodynamic assessment used to evaluate nerve mobility and sensitivity in the upper limb, particularly the median nerve and nerve roots C5–C7.​​
It is the upper-limb equivalent of the Straight Leg Raise Test used for the lower limb, and helps identify cervical radiculopathy, nerve entrapment, or neural tension dysfunction.

How the Test is Performed

  • Client position: Supine, head supported and relaxed, no pillow.​​

  • Therapist procedure:

    1. Depress the scapula to stabilize the shoulder and prevent elevation.​​

    2. Abduct the shoulder to about 90–110°, keeping the elbow flexed to 90°.​​

    3. Externally rotate the shoulder to open the anterior shoulder space.​

    4. Extend the wrist, fingers, and thumb while maintaining the shoulder position.​​

    5. Supinate the forearm (palm up).​​

    6. Slowly extend the elbow until symptoms are produced or muscle resistance is felt.​​

    7. To differentiate neural from muscular restriction, the therapist can laterally flex the neck away from the tested arm (increases tension) or toward it (decreases tension).​

  • A positive test:

    • Reproduction of the client’s familiar neurological symptoms—such as tingling, burning, or numbness in the distribution of the median nerve, or

    • Marked difference in mobility, pain, or resistance compared to the unaffected side.​​

    • Normal stretching sensations without neurological symptoms indicate a negative test.

Clinical Significance

  • A positive ULTT1 suggests neural tension or entrapment of the median nerve or its roots (C5–C7).  This is common in cervical radiculopathy, carpal tunnel syndrome, or thoracic outlet syndrome.​​

  • It helps distinguish between muscular tightness and nerve-related pain.

  • Sensitivity for detecting cervical radiculopathy is high (~97%), while specificity is moderate.​

  • The test also aids in monitoring nerve mobility improvements with treatment over time.​

Assessment

  • Use ULTT1 for clients presenting with:

    • Neck, shoulder, or arm pain

    • Paresthesia (tingling/numbness) in the forearm or hand

    • Suspected nerve entrapment or tension-related dysfunction

  • Document:

    • Side tested and sequence

    • Range at which symptoms arise

    • Nature, distribution, and intensity of symptoms

    • Comparison to contralateral (unaffected) limb​

Treatment

  • If positive:

    • Avoid aggressive stretching, deep soft tissue work, or positions that replicate nerve tension.

    • Focus instead on gentle nerve-gliding (flossing) techniques, myofascial release, and postural correction to improve tissue mobility and reduce compression.​

    • Address related contributing muscles (scalenes, pec minor, forearm flexors/extensors) to reduce nerve entrapment potential.

    • Educate the client on ergonomic setup, posture, and movement habits that relieve neural tension.

  • Reassess ULTT1 periodically to track improvement in symptom threshold and nerve mobility.

Safety and Referral

  • Refer to a physician or physiotherapist if:

    • Neurological symptoms are severe, progressive, or worsening;

    • Sensory/motor weakness develops;

    • There is a history of cervical trauma or systemic neurological disorder.

  • Severe neural tension may require medical imaging or electrodiagnostic studies