Upper and Lower Limb Tension Tests

Upper Limb Tension Tests: General Rules & Sequencing

Always test the good side first. Maintain constant depression force on shoulders. Joint positioning sequence starts with shoulder, followed by forearm, wrist, fingers, and elbow last (due to its large ROM). Contralateral cervical spine side bending or flexion can be added to further sensitize joints.

Upper Limb Tension Tests: Contraindications

 Cauda equina syndrome or spinal cord (SC) lesion; neurological signs in the acute phase or worsening.

ULNT1: Positioning

Shoulder depression & abduction (110∘ ), lateral rotation; Elbow extension; Forearm supination; Wrist extension; Fingers/thumb extension; Cervical spine contralateral side flexion.

ULNT1: Nerve Bias

Median nerve; anterior interosseous nerve; C5, C6, and C7 nerve roots.

ULNT2: Positioning

Shoulder depression, abduction (10∘ ), lateral rotation; Elbow extension; Forearm supination; Wrist extension; Fingers/thumb extension; Cervical spine contralateral side flexion.

ULNT2: Nerve Bias

Median nerve, musculocutaneous nerve, axillary nerve.

ULNT3: Positioning

Shoulder depression, medial rotation, abduction (40∘ ), extension (25∘ ); Elbow extension; Forearm pronation; Wrist flexion & ulnar deviation; Fingers/thumb flexion; Cervical spine contralateral side flexion.

ULNT3: Nerve Bias

Radial nerve.

ULNT4: Positioning

Shoulder depression, abduction (10∘ −90), hand to ear, lateral rotation; Elbow flexion; Forearm supination or pronation; Wrist extension & radial deviation; Fingers/thumb extension; Cervical spine contralateral side flexion.

ULNT4: Nerve Bias

Ulnar nerve, C8 and T1 nerve roots.

Slump Test 1 (ST1): Positioning & Nerve Bias

Cervical spine flexion; Thoracic/lumbar spine flexion (slump); Hip flexion (>90∘ ); Knee extension; Ankle DF: Biases spinal cord, cervical and lumbar nerve roots, sciatic nerve.

Slump Test 2 (ST2): Positioning & Nerve Bias

Cervical spine flexion; Thoracic/lumbar spine flexion (slump); Hip flexion (≥90∘ ) & ABD; Knee extension; Ankle DF: Biases obturator nerve.

Side-Lying Slump Test (ST3): Positioning & Nerve Bias

Cervical spine flexion; Thoracic/lumbar spine flexion (slump); Hip flexion (20∘); Knee flexion; Ankle PF: Biases femoral nerve.

Long-Sitting Slump Test (ST4): Positioning & Nerve Bias

Cervical spine flexion & rotation; Thoracic/lumbar spine flexion (slump); Hip flexion (90∘); Knee extension; Ankle DF: Biases spinal cord, Cx and Lx nerve roots, sciatic nerve.

Slump Test Sequence: Relief Mechanism

In the slumped position with knee extended and foot dorsiflexed, having the patient extend their head should relieve any symptoms if due to neural tension; if symptoms are reproduced at any stage, further sequential movements are not attempted.

Supine Straight Leg Raising (SLR): Neural Tension Mechanism

Hip flexion, adduction, internal rotation (IR), knee extension, and ankle dorsiflexion (DF) increase neural tension. Neck flexion can be added simultaneously with ankle DF.

SLR (Basic): Positioning & Nerve Bias

Hip flexion & adduction; Knee extension; Ankle DF: Biases sciatic and tibial nerves.

SLR2: Positioning & Nerve Bias

Hip flexion; Knee extension; Ankle DF; Foot eversion; Toes extension: Biases tibial nerve.

SLR3: Positioning & Nerve Bias

Hip flexion; Knee extension; Ankle DF; Foot inversion: Biases sural nerve.

SLR4: Positioning & Nerve Bias

Hip flexion & medial rotation; Knee extension; Ankle PF; Foot inversion: Biases common peroneal nerve.

Crossed SLR / SLR5 (Well Leg): Positioning & Nerve Bias

Hip flexion; Knee extension; Ankle DF performed on the unaffected leg: Biases nerve root (disc prolapse).