Wrist and Hand Mobilisations

Introduction[edit | edit source]

Definition-It is passive skilled manual therapy techniques applied on the joints of the body.

  • One “tool” in the therapist “toolbox”
  • Used only after determined by a thorough evaluation that joint mobilization is needed
  • More effective if combined with an active rehabilitation program

Indications[edit | edit source]

Joint hypomobility.

Contraindications[edit | edit source]

Wrist and Hand mobilization aims to restore normal joints ROM or facilitate hand function.[1] When mobilizing wrist and hand there are some priorities that should be taken into consideration[2]:

  • Unstable joint. Healing fracture-involved or adjacent joint. Acute inflammation. Bony disease[3]
  • The radioulnar joint should be mobilized in mid position. regaining pronation is the priority, as it generally has a greater functional value than supination.
  • Hand functions more effectively with the wrist in some degree of an extension, which enables long flexors of the fingers to produce a stronger grip than with the wrist in flexion. However, wrist flexion is necessary for some functions, such as placing food in the mouth with a spoon, eating maybe therefore be difficult when wrist flexion is limited.
  • Flexion combined with lateral rotation of the fifth metacarpal joint helps to deepen the distal palmar arch and allows pulp-to-pulp pinch of the little finger and thumb.
  • Restoring the thumb to a functional position and improving its range of motion will need urgent consideration.
  • Palmar abduction and opposition at the CMC joint must be adequate to enable the thumb to approximate to the tips of the fingers.
  • Therapists should consider Activities of daily living, the patient's occupation, and leisure activities.
  • It’s important to improve the movements of grasp, pinch grip, and finger flexion before extension.
  • A combination of thermal ultrasound and joint mobilizations is effective in restoring AROM to hands and wrists lacking ROM after injury or surgery[4].
  • When applying wrist mobilization, one has to start with a general distraction of the radiocarpal joint that will include both the rows of carpal bones. After the general mobilization, carpal bones have to be mobilized individually for achieving full ROM.

Distal Radioulnar Joint Mobilization[edit | edit source]

Procedure[edit | edit source]

To perform mobilizations at the distal radioulnar joint the therapist stabilizes patient’s hand and radiocarpal region by placing the index finger in the web of the patient’s thumb and the thenar eminences and middle, ring, and little fingers grasping the distal radius and proximal carpals.

Therapist grasps the distal ulna between the thumb and pads of the fingers.

Then provides anteroposterior glide and medial and lateral rotary joint play movements of the distal ulna.

Indication[edit | edit source]

These motions can be used to increase joint-play and promote greater pronation and supination at the distal radioulnar joint. Other techniques may be used if restriction to pronation/supination motion is caused by proximal radio-ulnar hypomobility.

[5]

Dorsal-Palmar Glide at Radiocarpal Joint[edit | edit source]

Procedure[edit | edit source]

The therapist's proximal hand stabilizes the patient’s elbow flexed to 90 degrees.

The distal hand grasps the radiocarpal joint just distal to the radial and ulnar styloid processes.

The therapist takes up a long-axis extension to the barrier.

Indication[edit | edit source]

The mobilization involves moving the row of carpal bones either dorsally to promote wrist extension or palmar to promote wrist flexion. These techniques may also be performed to hypermobile wrist following prolonged immobilization (casting).

[6]

Radio Carpal Joint - Ulnar and Radial Glide[edit | edit source]

Procedure[edit | edit source]

  • The wrist is kept in mid-range position.
  • The force is applied by the hand of the therapist around the distal row of carpals.[7]

Indication[edit | edit source]

  • Ulnar glide is for increasing radial deviation and radial glide is for increasing ulnar deviation of the wrist joint.

Mid-Carpal (and Radiocarpal) Distraction[edit | edit source]

Procedure[edit | edit source]

These two techniques are performed in a similar manner using slightly different hand positions.

For mid-carpal distraction, the stabilizing hand is placed over the styloid processes and the mobilising hand is placed over the distal carpal row (for radiocarpal distraction, the mobilising hand is over the proximal carpal row).

Indication[edit | edit source]

These techniques are used to increase generalized wrist mobility and open the joint spaces, allowing for greater movement into wrist extension since it is the closed-packed position of the wrist.

[8]

Mid-Carpal Dorsal-Palmar Glide[edit | edit source]

Procedure[edit | edit source]

The stabilizing hand grasps the patient's wrist just proximal to the styloid processes to stabilize the distal radioulnar joint.

The mobilizing hand is placed over the distal carpal row.

Indication[edit | edit source]

The mobilization involves gliding the row of carpal bones either dorsally to promote wrist flexion or palmar to promote wrist extension.

[9]

Thumb Metacarpal-Carpal Radial and Ulnar Glides[edit | edit source]

Procedure[edit | edit source]

Patient’s hand is positioned with the ulnar side down, joint in a resting position; stabilizing hand grasps distal forearm with the grip around trapezium while mobilizing hand grasps the first metacarpal

With mobilizing hand, glide metacarpal toward radius to increase extension, or toward ulna to increase flexion while applying gentle traction

Indication[edit | edit source]

Ulnar glide to increase flexion; radial glide to increase extension.

Thumb Metacarpal-Carpal Dorsal and Palmar Glides[edit | edit source]

Procedure[edit | edit source]

Patient’s hand is positioned with the palm down, joint in a resting position; stabilizing hand grasps distal forearm with the grip around trapezium while mobilizing hand grasps the first metacarpal. With mobilizing hand, glide metacarpal toward palm to increase adduction, or toward dorsum to increase abduction while applying gentle traction[10]

Indication[edit | edit source]

Palmar glide to increase adduction; dorsal glide to increase abduction

MCP/IP Distraction[edit | edit source]

Prcocedure[edit | edit source]

The therapist must support the forearm of the patient first, then grip the proximal bone of the joint being mobilized with one hand and the distal bone between the thumb and index finger of the mobilizing hand.

With the joint slightly flexed, distraction is imparted using the mobilizing hand.

Indication[edit | edit source]

These techniques are used to promote general joint play and also to promote MCP flexion and IP extension.

[11]

MCP/IP Dorsal or Palmar Glides[edit | edit source]

Procedure[edit | edit source]

The therapist must support the forearm of the patient first, then grip the proximal bone of the joint being mobilised with one hand and the distal bone between the thumb and index finger of the mobilising hand.

Indication[edit | edit source]

The mobilization is imparted by moving the base of the distal bone either palmar or dorsal, promoting either flexion or extension, respectively.

[12]
[13]

References[edit | edit source]

  1. DeStefano L, Greenman P. Greenman's principles of manual medicine. Philadelphia: Lippincott Williams & Wilkins; 2011.
  2. Salter M, Cheshire L. Hand therapy. Oxford: Butterworth-Heinemann; 2000.
  3. Powerpoint PDF Outline for Joint Mobilization of the Upper Extremity Available from:https://www.liveconferences.com/docs/jtmob.pdf (last accessed 4.4.2020)
  4. Draper DO. Ultrasound and joint mobilizations for achieving normal wrist range of motion after injury or surgery: a case series. Journal of athletic training. 2010 Sep;45(5):486-91. Available from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2938322/ (last accessed 4.4.2020)
  5. Joint Mobilizations. Distal radioulnar joint mobilizations. Available from: https://www.youtube.com/watch?v=mJ0mx1l7MzY[last accessed 30/10/17]
  6. Physical Therapy Nation. Radio-Carpal Mobilizations. Available from: https://www.youtube.com/watch?v=XZuVTiU8zBI[last accessed 30/10/17]
  7. Kisner C, Colby LA, Borstad J. Therapeutic exercise: foundations and techniques. Fa Davis; 2017 Oct 18.
  8. sara asensio. Global traction of the Radiocarpal joint. Available from: https://www.youtube.com/watch?v=fruGgh6uSTM[last accessed 30/10/17]
  9. Cinesiterapia Tema 3 Subgrupo C. Midcarpal joint Palmar gliding capitate lunate. Available from: https://www.youtube.com/watch?v=HepWRITJdMk[last accessed 30/10/17]
  10. Hall & Brody: Therapeutic Exercise: Moving Toward Function, 2nd Edition © 2005, Lippincott Williams and Wilkins Wrist and hand mobilisation Available from:http://download.lww.com/downloads/thePoint/9780781741354_Hall/Image_Bank/pdf/0350_ch_07-box10.pdf
  11. UBCCchiro2014. 4Th- Metacarpophalangeal and Interphalangeal Joints. Available from: https://www.youtube.com/watch?v=ZFz6XnS8opY[last accessed 30/10/17]
  12. LearningMovementsUBCCchiro2014. CMC Posterior Mobilization. Available from: https://www.youtube.com/watch?v=4VPLB5fMyvQ[last accessed 30/10/17]
  13. Joint Mobilizations. MCP and IP joint mobilizations. Available from: https://www.youtube.com/watch?v=q8C0N_Fa9E0[last accessed 30/10/17]