A physical therapist is preparing to perform all upper limb tension tests (ULTTs) on a patient with upper extremity paresthesia. The patient's medical history includes osteoarthritis of the elbow and their passive range of motion is 0 to 95 degrees. Which test would be the MOST difficult to perform given the patient's elbow mobility restriction?

1. ULTT 1 (median nerve bias)
2. ULTT 2 (median, musculocutaneous, axillary nerve bias)
3. ULTT 3 (radial nerve bias)
4. ULTT 4 (ulnar nerve bias)

Transcript

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A physical therapist is preparing to perform all upper limb tension tests (ULTTs) on a patient with upper extremity paresthesia. The patient's medical history includes osteoarthritis of the elbow and their passive range of motion is 0 to 95 degrees. Which test would be the MOST difficult to perform given the patient's elbow mobility restriction?

1. ULTT 1 (median nerve bias)
2. ULTT 2 (median, musculocutaneous, axillary nerve bias)
3. ULTT 3 (radial nerve bias)
4. ULTT 4 (ulnar nerve bias)

Upper Limb Tension Tests

Upper limb tension tests are neurodynamic tests designed to assess the mechanical sensitivity of peripheral nerves. These tests involve a specific sequence of movements that progressively increase tension on neural structures.

This question is asking you to think about the specific movement components of each upper limb tension tests and determine which one would be most affected by limited elbow range of motion.

Remember, our patient has elbow range of motion of 0 to 95 degrees. That means they have full extension (0 degrees) but limited flexion (only to 95 degrees). So we need to consider which test requires significant elbow flexion beyond what our patient can achieve.

Let's explore each of the options:

Option 1 – ULTT 1 (median nerve bias)

Upper limb tension test 1 targets the median nerve and involves a specific sequence of movements: shoulder depression, shoulder abduction to 90 degrees, forearm supination, wrist and finger extension, and finally, elbow extension. The key point here is that this test requires elbow EXTENSION, not flexion. Since our patient has 0 degrees of elbow extension, they have full capacity for this movement. No problem performing this test.

Option 2 – ULTT 2 (median, musculocutaneous, axillary nerve bias)

Upper limb tension test 2 targets the median, musculocutaneous, and axillary nerves. This test involves shoulder depression, shoulder external rotation, forearm supination, wrist and finger extension, and elbow extension. Again, this test requires elbow EXTENSION rather than flexion. With the patient's available range of 0 to 95 degrees, full elbow extension is possible, allowing for proper test performance. This test should be fine to perform.

Option 3 – ULTT 3 (radial nerve bias)

Upper limb tension test 3 targets the radial nerve and involves shoulder depression, shoulder extension, shoulder internal rotation, forearm pronation, wrist and finger flexion, and elbow extension. Just like the previous two tests, ULTT 3 requires elbow extension, which is within our patient's available range of motion. Therefore, this test can be performed adequately despite the patient's elbow osteoarthritis.

Option 4 – ULTT 4 (ulnar nerve bias)

Upper limb tension test 4 targets the ulnar nerve and involves a unique sequence: shoulder depression, shoulder abduction to 90 degrees, shoulder external rotation, forearm supination or pronation, wrist extension with radial deviation, finger extension, and critically, elbow FLEXION. This is the only upper limb tension test that requires elbow flexion rather than extension. And not just any flexion - it typically requires flexion to around 110 to 130 degrees to provide tension to the ulnar nerve as it passes through the cubital tunnel.

With the patient's elbow range limited to 95 degrees due to osteoarthritis, achieving the necessary degree of elbow flexion would be difficult, making this test the most challenging to perform properly. Boom! The answer is clear now.

The correct answer is Option 4.

Let's explore the all student data:
10% of students selected Option 1 – ULTT 1 (median nerve bias)
15% of students selected Option 2 – ULTT 2 (median, musculocutaneous, axillary nerve bias)
5% of students selected Option 3 – ULTT 3 (radial nerve bias)
70% of students selected the correct response of Option 4 – ULTT 4 (ulnar nerve bias)

System Classification
This question is a Musculoskeletal System question which represents approximately 27% of all exam items.

Content Outline Classification
This question is a Physical Therapy Examination question which represents approximately 24% of all exam items.

Level Classification
This question is a Level 2 question since the question requires students to integrate numerous pieces of information or to apply knowledge in a given clinical scenario. Remediation of Level 2 questions occurs by increasing flexibility with academic content and by carefully analyzing decision making processes when answering applied examination questions.

Academic Focus Area
Looking to review related academic content? Check out page 107 in PTEXAM: The Complete Study Guide.


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