Upper Limb Tension Test 2B is commonly used as a radial nerve-biased neurodynamic test. It assesses whether radial nerve-biased loading reproduces familiar symptoms and whether those symptoms change with structural differentiation. A 2021 diagnostic accuracy study found that single ULNTs have limited stand-alone diagnostic value for cervical radiculopathy, while combinations of ULNTs are more useful for changing post-test probability.
A client reports posterolateral forearm symptoms, lateral elbow discomfort, dorsal hand symptoms or arm symptoms that change with neck and wrist position. Lateral elbow pain may look like tendinopathy, but neural sensitivity can contribute to symptom behaviour.
Upper Limb Tension Test 2B can help assess radial nerve-biased neurodynamic symptom response. It should be interpreted with cervical assessment, lateral elbow tests, radial nerve symptoms, grip tolerance and functional history.
Test name: Upper Limb Tension Test 2B
Also known as: ULNT2B, ULTT2B, Radial Nerve Bias Test
Body region: Cervical spine, brachial plexus, radial nerve pathway and upper limb
Purpose: Assess radial nerve-biased neurodynamic symptom response
Positive finding: Familiar symptoms reproduced and changed by structural differentiation
Negative finding: No familiar symptoms or no meaningful neurodynamic symptom change
Best used with: Cozen’s, Maudsley’s, Mill’s, cervical ROM, neurological screen and grip testing
Key limitation: Single ULNTs should not be used as stand-alone diagnostic tests
Upper Limb Tension Test 2B is a neurodynamic test that biases the radial nerve pathway. The sequence often includes shoulder girdle depression, shoulder internal rotation, elbow extension, forearm pronation, wrist/finger flexion and ulnar deviation, with cervical side flexion used for structural differentiation.
Exact sequencing may vary, so the version used should be recorded.
ULTT2B is used when radial nerve mechanosensitivity or cervical radicular symptom behaviour is being considered.
It may be relevant in clients with lateral elbow pain, dorsal forearm symptoms, radial nerve distribution symptoms, neck-related arm pain or symptoms that change with wrist and cervical movement.
The test assesses symptom response to radial nerve-biased neurodynamic loading. It does not diagnose radial nerve entrapment, cervical radiculopathy or lateral elbow tendinopathy on its own.
Symptoms may reflect neural mechanosensitivity, muscle stretch, joint stiffness, cervical contribution, radial tunnel-type symptoms, lateral elbow tendinopathy or pain sensitivity.
This test may be useful for clients with posterolateral forearm symptoms, dorsal hand symptoms, lateral elbow pain with neural features, neck-related arm pain or symptoms influenced by posture and wrist movement.
Use when radial nerve-biased neurodynamic assessment is relevant and the client can tolerate gradual positioning.
Use caution with acute nerve injury, severe neurological signs, progressive weakness, acute trauma, recent surgery, high irritability, vascular symptoms or symptoms that remain aggravated after testing.
Treatment table
Pain and symptom scale
Measurz recording workflow
Optional goniometer or inclinometer
Optional neurological screen notes
Position the client supine near the edge of the table.
The tested arm is accessible and relaxed.
Stand beside the tested arm.
Support the shoulder, elbow, wrist and hand while guiding each component.
Control shoulder girdle position and avoid trunk compensation.
Use the selected radial nerve-biased sequence, commonly including shoulder depression, shoulder internal rotation, elbow extension, forearm pronation, wrist/finger flexion and ulnar deviation. Use cervical side flexion or release of distal components for structural differentiation.
Ask the client to report pain, stretch, tingling, numbness, burning, symptom location and whether symptoms are familiar.
A positive result is familiar symptom reproduction that changes meaningfully with structural differentiation.
A negative result is no familiar symptoms or no meaningful structural differentiation response.
Stop if symptoms increase sharply, neurological symptoms worsen, paraesthesia persists, dizziness occurs or the position is not tolerated.
Move gradually and avoid forcing end range. Record which component reproduced or eased symptoms.
A positive ULTT2B may suggest radial nerve-biased neurodynamic sensitivity when familiar symptoms are reproduced and altered by structural differentiation.
A positive result does not identify the site of involvement. It may overlap with lateral elbow tendinopathy, radial tunnel symptoms, cervical radiculopathy or general upper-limb sensitivity.
A negative result decreases suspicion of radial nerve-biased neurodynamic sensitivity under the tested conditions, but it does not exclude radial nerve involvement or cervical radicular contribution.
A 2021 diagnostic accuracy study assessed ULNT1, ULNT2A, ULNT2B and ULNT3 in suspected cervical radiculopathy. Single ULNTs generally did not significantly alter post-test probability when used alone. Three of four positive ULNTs had LR+ 12.89, and no positive ULNTs had LR- 0.08.
Condition or presentation: cervical radiculopathy
Population: 85 people with suspected cervical radiculopathy
Test variation: ULNT2B included as one of four ULNTs
Reference standard: clinical diagnosis and MRI verification by a neurosurgeon
Sensitivity: not provided for ULTT2B alone in the accessible summary
Specificity: not provided for ULTT2B alone in the accessible summary
Positive likelihood ratio: strongest in combination, LR+ 12.89 when 3 of 4 ULNTs were positive
Negative likelihood ratio: LR- 0.08 when all ULNTs were negative
Key limitations: single ULNTs had limited stand-alone value; combined testing performed better
A 2025 systematic review reported that diagnostic accuracy of upper-limb neurodynamic tests remains uncertain across upper-limb entrapment neuropathies and criteria.
A 2022 reliability study reported moderate to excellent reliability for upper limb neurodynamic tests overall, but radial nerve testing showed lower and more variable reliability than median nerve testing in some comparisons.
Reliability improves when the same sequence, endpoint, symptom criteria and measurement method are used.
Common errors include confusing radial nerve symptoms with lateral elbow tendinopathy, forcing wrist flexion, skipping structural differentiation, not recording symptom distribution and using the test as a diagnosis.
Limitations include variable sequence, overlapping tendon and nerve symptoms, sensitivity to force, pain irritability and uncertain stand-alone diagnostic accuracy.
Use ULTT2B to document radial nerve-biased symptom behaviour and to differentiate possible neural contribution from lateral elbow loading symptoms.
Record test name, side tested, result as positive, negative, unclear or unable to test, exact sequence used, symptom onset component, pain score, symptom distribution, structural differentiation response, cervical position, elbow angle if measured, wrist position, comparison side, irritability, confidence in result and reason for stopping.
Add related findings such as Cozen’s, Maudsley’s, Mill’s, grip strength, cervical screen, neurological screen and functional loading notes.
Cozen’s Test
Maudsley’s Test
Mill’s Test
Upper Limb Tension Test I
Upper Limb Tension Test 2A
Upper Limb Tension Test 3
Arm Squeeze Test
Cervical ROM Tests
It assesses radial nerve-biased neurodynamic symptom response.
A positive result is familiar symptom reproduction that changes with structural differentiation.
No. It may support suspicion but does not diagnose radial nerve entrapment on its own.
It can help identify whether radial nerve-biased symptom behaviour may contribute to lateral elbow or forearm symptoms.
Record sequence, symptom onset point, symptom distribution, structural differentiation response and comparison side.
ULTT2B is a radial nerve-biased neurodynamic test.
It should include symptom reproduction and structural differentiation.
It does not diagnose radial nerve entrapment or cervical radiculopathy on its own.
Radial nerve findings may overlap with lateral elbow pain presentations.
Measurz should capture sequence, symptoms, differentiation and related elbow findings.
Grondin, F., Cook, C., Hall, T., Maillard, O., Perdrix, Y., & Freppel, S. (2021). Diagnostic accuracy of upper limb neurodynamic tests in the diagnosis of cervical radiculopathy. Musculoskeletal Science and Practice, 55, 102427.
Taheri, M., Talebi, G., Taghipour, M., Bahrami, M., & Gholinia, H. (2022). Reliability of upper limb neurodynamic tests: Median, radial, and ulnar nerves. Journal of Rehabilitation, 23(3), 334–351.
