Execution
- 1Position the patient supine with the shoulder girdle controlled.
- 2Depress the shoulder, abducts the shoulder, extends the wrist and fingers, and externally rotates the shoulder.
- 3Gradually extend the elbow while maintaining the distal limb position.
- 4Add structural differentiation such as cervical side flexion or wrist / finger release when symptoms are reproduced.
- 5Compare symptom location, range, resistance, and side-to-side difference.
Positive outcome
Reproduction of the patient’s familiar median nerve symptoms that changes with structural differentiation is positive. For CTS, hand symptoms in the thumb or lateral fingers are more meaningful than diffuse arm stretch alone. Normal neural stretch discomfort should be compared with the opposite side.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Vanti et al. (2012) | NA | NA | NA | NA | NA |
| Bueno-Gracia et al. (2016) | NA | 57.9 | 84.2 | 3.66 | 0.50 |
| Trillos et al. (2018) | NA | NA | NA | NA | NA |
CommentULNT1 is useful for mechanosensitivity but is not a pure carpal tunnel test. Diagnostic performance depends heavily on how the test is interpreted and whether structural differentiation is required. Use it to understand neural contribution and irritability rather than to replace CTS-specific tests.
Moderate Clinical Value