Execution
- 1Have the patient lie supine with the head and neck in neutral.
- 2Depress the shoulder girdle and abduct the shoulder to about 110°.
- 3Extend the wrist, fingers, and thumb, then supinates the forearm and externally rotates the shoulder.
- 4Slowly extend the elbow while maintaining shoulder depression and the distal limb position.
- 5If needed, examiner adds contralateral cervical side flexion as a sensitising movement, then compares with ipsilateral side flexion or the opposite limb.
Positive outcome
Reproduction of the patient's familiar arm symptoms, especially shooting pain, paresthesia, or neural symptoms in a median nerve / C5-C7 distribution. A positive response is strengthened when symptoms change with cervical sensitising movements or differ clearly from the opposite side.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Wainner et al. (2003) | 0.76 | 97 | 22 | 1.24 | 0.14 |
| Sandmark & Nisell (1995) | NA | 77 | 94 | 12.83 | 0.24 |
CommentULNT1 is commonly used as a sensitive neurodynamic screen for cervical radiculopathy, but specificity varies widely by study and diagnostic reference standard. It is strongest clinically when interpreted with Spurling, cervical rotation, and distraction findings rather than as an isolated rule-in test. Reference-standard caveat: Sandmark & Nisell 1995 used self-reported neck pain (not cervical radiculopathy via electrodiagnosis or imaging) as the reference, so its 77/94 figures answer a different diagnostic question than Wainner. The Wainner 2003 figures (Sn 97 / Sp 22) are a more direct test of cervical radiculopathy and emphasise screening rather than rule-in.
High Clinical Value