Wrist/Hand Mobilizations

Original Editor - David Drinkard

Top Contributors - David Drinkard and Laura Ritchie  

Introduction

There are a multitude of mobilisations/manipulations that can be performed for the wrist, hand, and fingers due to the complex bony architecture of this region. Therefore, a selection of those techniques are outlined below:

Dorsal-Ventral Glide at Distal Radioulnar Joint:

The patient's forearm should be rested on a plinth in neutral position between pronation and supination. The radius is stabilised near the wrist using the mobilising hand. The opposite hand grasps the distal ulna between the thumb on one side and the 2nd and 3rd fingers on the other. The mobilisation involves moving the ulna dorsal or palmar to the radius. 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.

Dorsal-Palmar Glide at Radiocarpal Joint:

The forearm is rested on a mat/table with the hand just extending off the edge of the surface. The stabilising hand grasps the patient's wrist just proximal to the styloid processes to stabilise the distal radioulnar joint. The mobilising hand is placed over the proximal carpal row. The mobilisation 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 wrist that are generally hypomobile following prolonged immobilisation (casting).

Mid-Carpal (and Radiocarpal) Distraction:

These two techniques are performed in a similar manner using slightly different hand positions. For mid-carpal distraction, the stabilising 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). These techniques are used to increase generalised wrist mobility and open the joint spaces, allowing for greater movement into wrist extension since it is the closed-packed position of the wrist.

Mid-Carpal Dorsal-Palmar Glide:

The forearm is rested on a mat/table with the hand just extending off the edge of the surface. The stabilising hand grasps the patient's wrist just proximal to the styloid processes to stabilise the distal radioulnar joint. The mobilising hand is placed over the distal carpal row. The mobilisation involves moving the row of carpal bones either dorsally to promote wrist flexion or palmar to promote wrist extension. 

MCP/IP Distraction:

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. With the joint slight flexed, distraction is imparted using the mobilising hand. These techniques are used to promote general joint play and also to promote MCP flexion and IP extension.

MCP/IP Dorsal or Palmar Glides:

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

References