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Upper Limb Tension Test
The Upper Limb Tension test is also known as the Brachial Plexus Tension test and the Elvey’s test. This test is designed to detect involvement of the neural pathways from the cervical spine to the hand including the nerve roots, brachial plexus, and peripheral nerves.
The Upper Limb Tension test is performed with several variations depending on which peripheral nerve tension is being emphasized. The procedure described in this video is for median nerve bias.
The procedure described in this video is for the median nerve bias. The test is performed in several steps by placing the patient in a series of positions to gradually and progressively stretch the neural structures. At each stage of the test, stop, and ask the patient if there is a reproduction or exacerbation of their upper extremity symptoms. If so, this would constitute a positive result.
To begin, the patient is in the supine position with their arm resting against your thigh in a few degrees of shoulder abduction, their elbow flexed to 90 degrees, and their wrist and hand in the neutral position. Now, gently depress the shoulder. If no symptoms are experienced, hold the shoulder depression and, using the thigh, push their arm into 90 degrees of shoulder abduction.
If no symptoms are experienced, maintain this position, and now extend the patient’s wrist and fingers. If no symptoms are experienced, supinate the forearm. If no symptoms are experienced, externally rotate the shoulder. If no symptoms are experienced, gradually extend the elbow. The test is considered positive if, at any stage during the procedure, neurological symptoms are reproduced or exacerbated.
Some authors advocate using lateral flexion of the cervical spine as a means of confirming neural tension. They consider that if lateral flexion of the neck to the opposite side aggravates the symptoms, and lateral flexion to the same side relieves them, then a neurological cause is most likely. If a positive result occurs in the procedure described in this video, it suggests involvement of the C8 and T1 nerve roots, the medial cord of the brachial plexus, or the median nerve.
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