Upper and Lower Limb Tension Tests. NPTE Study Guide: Master the NPTE

Upper Limb Tension Tests (ULT): Put stress on UE neurological structures by stretching them. This test is divided into 4 other tests. The tests are + if neurological symptoms manifest before 60° elbow ext when elbow ext is the last movement done. Always test good side 1st. Start w/ shoulder, followed by forearm, wrist, fingers, & elbow last (because of its large ROM). Can add contralateral cervical spine side bending or flexion to further “sensitize” joints. Maintain constant depression force on shoulders. Contraindications: Cauda equina syndrome or spinal cord (SC) lesion & Neurological signs in acute phase or worsening. 

TABLE: Upper Limb Neurodynamic (Tension) Tests Indicating Order of Joint Positioning and Nerve Bias

ULT1

ULT2

ULT3

ULT4

Shoulder

Depression & ABD (110°)

Depression & ABD (10°)

Depression, medial

rotation, ABD(40°), & extension (25°)

Depression & ABD (10-90°), hand to ear

Elbow

Extension

Extension

Extension

Flexion

Forearm

Supination

Supination

Pronation

Either/Or

Wrist

Extension

Extension

Flexion and UD

Extension and RD

Fingers

Extension

Extension

Flexion

Extension

Cervical spine

Contralateral side flex

Contralateral side flex

Contralateral side flex

Contralateral side flex

Nerve bias

Median; anterior

interosseous; C5, C6, & C7 nerve roots

Median, axillary, & musculocutaneous

Radial nerve

Ulnar nerve, C8 and T1 nerve roots

Lower Limb Tension Tests:

TABLE: Slump Test and Its Modifications.

Slump Test 1

Slump Test 2

Side-Lying Slump Test

Long-Sitting

Slump Test

Cervical spine

Flexion

Flexion

Flexion

Flexion, rotation

Thoracic &

lumbar spines

Flexion (slump)

Flexion (slump)

Flexion (slump)

Flexion (slump)

Hip

Flexion (≥ 90°)

Flexion (≥ 90°)

Flexion (20°)

Flexion (≥ 90°)

Knee

Extension

Extension

Flexion

Extension

Ankle

DF

DF

PF

DF

Nerve bias

Spinal cord, cervical

& lumbar nerve

roots, sciatic nerve

Obturator nerve

Femoral nerve

Spinal cord, Cx & Lx

nerve roots, sciatic

nerve

FIGURE: Slump Test sequence: 

A) Sitting erect with hands behind back. 

B) Head neutral, thoracic and lumbar spine slumped. 

C) Head neutral, therapist pushes down on shoulder 

D) Patient flexes head. 

E) Overpressure to cervical spine. 

F) Cervical spine flexed, therapist extends the knee. 

G) Dorsiflexion of foot.

H) Patient extends head, it should relieve any symptoms. 

If symptoms are reproduced at any stage, further sequential movements are not attempted.

FIGURE: Modifications of the Slump Test:  

A) Basic Test; 

B) Obturator Nerve; 

C) Femoral Nerve; 

D) Spinal Cord, Nerve Roots.

Straight leg raising test modifications: For the supine SLR test, hip flexion, adduction, internal rotation, knee extension, & ankle dorsiflexion will increase neural tension. The SLR test is continued until same-side symptoms are observed. Then leg is lowered until pain is relieved. Then additional positionings are added to find nerve bias. Can also add neck flexion at the same time as ankle DF

TABLE: Straight Leg Raising Test and Its Modifications.

SLR (Basic)

SLR2

SLR3

SLR4

SLR5

Crossed SLR

(well leg)

Hip

Flexion and ADD

Flexion

Flexion

Flexion and medial

rotation

Flexion

Knee

Extension

Extension

Extension

Extension

Extension

Ankle

DF

DF

DF

PF

DF

Foot

Eversion

Inversion

Inversion

Toes

Extension

Nerve Bias

Sciatic and tibial

Tibial nerve

Sural nerve

Common peroneal nerve

Nerve root

(disc prolapse)