Test procedures and positive diagnostic criteria of the upper limb tension tests differ: a systematic review of the DiTA database

Arianne P Verhagen; Hayley Brown; Mark Hancock; David Anderson

doi:10.1016/j.bjpt.2023.100558

Test procedures and positive diagnostic criteria of the upper limb tension tests differ: a systematic review of the DiTA database

Braz J Phys Ther. 2023 Nov-Dec;27(6):100558. doi: 10.1016/j.bjpt.2023.100558. Epub 2023 Nov 10.

Authors

Arianne P Verhagen¹, Hayley Brown², Mark Hancock³, David Anderson⁴

Affiliations

¹ Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, Australia. Electronic address: arianne.verhagen@uts.edu.au.
² Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, Australia.
³ Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
⁴ School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Sydney Spine Institute Research Group, Sydney Spine Institute, Burwood, Sydney, Australia.

Abstract

Background: The validity of the ULTT is unclear, due to heterogeneity of test procedures and variability in the definition of a positive test OBJECTIVE: To evaluate test procedures and positive diagnostic criteria for the upper limb tension test (ULTT) in diagnostic test accuracy studies.

Methods: A systematic review of diagnostic accuracy studies was performed. We conducted a search of the DiTA (Diagnostic Test Accuracy) database and selected primary studies evaluating the diagnostic accuracy of the ULTT. We assessed risk of bias, performed data extraction on study characteristics, test procedures, and positive diagnostic criteria, and performed a descriptive analysis.

Results: We included nine studies (681 participants), four diagnosing people with cervical radiculopathy (CR), four diagnosing people with carpal tunnel syndrome (CTS), and one included both CR and CTS. The risk of bias varied between 2 and 6 out of 6 positive items. Eight studies reported on the ULTT1 (median nerve). Overall, all studies clearly described their test procedures and positive diagnostic criteria although the order of movements and the diagnostic criteria between studies varied. We suggest a more standardised test procedure for the ULTT1 to consist of: 1) stabilising the shoulder in abduction, 2) extending the wrist/fingers, 3) supinating the forearm, 4) externally rotating the shoulder, 5) extending the elbow, and finally 6) performed structural differentiation by side bending (lateral flexion) of the neck. This proposed test procedure should reproduce the symptoms and enables the clinician to evaluate whether symptoms increase/decrease when stressing or relaxing the nerves.

Conclusion: Based on our findings we proposed a more standardised test procedure for the ULTT1 with accompanying positive diagnostic criteria to facilitate homogeneity in future diagnostic accuracy studies of the ULTT.

Keywords: Diagnostic accuracy; Positive diagnostic criteria; Positivity threshold; Systematic review; Test procedures; Upper limb tension test.

Publication types

Systematic Review
Review

MeSH terms

Carpal Tunnel Syndrome* / diagnosis
Fingers
Humans
Physical Examination*
Upper Extremity / physiology
Wrist