Wrist and Hand Mobilisations

Original Editor - David Drinkard

Top Contributors - Mariam Hashem, Kim Jackson, Laura Ritchie, David Drinkard and Evan Thomas

Introduction

Definition-skilled passive movement of a joint

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

Indications

  • Joint hypomobility

Contraindications

  • Unstable joint. Healing fracture-involved or adjacent joint. Acute inflammation. Boney disease[1]

Wrist and Hand mobilization aims to restore normal joints ROM or facilitate hand function.[2] When mobilizing wrist and hand there are some priorities that should be taken into consideration[3]:

  • Radioulnar joint should be mobilized in mid position. regaining pronation is the priority, as it generally has a greater functional value than supination.
  • Hand function more effectively with wrist in some degree of extension, which enables long flexors of the fingers to produce a stronger grip than with wrist in flexion.However, wrist flexion is necessary in some functions, such as placing food in mouth with a spoon, eating maybe therefore 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 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 thumb to approximate to the tips of the fingers.
  • Therapist should consider: Activities of daily living, 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].

Distal Radioulnar Joint Mobilization:

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.

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

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

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

Therapist takes up long-axis extension to the barrier.

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 hypomobile wrist following prolonged immobilisation (casting).

[6]

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 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.

[7]

Mid-Carpal Dorsal-Palmar Glide

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

The mobilizing hand is placed over the distal carpal row.

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

[8]

Thumb metacarpal-carpal radial and ulnar glides

Purpose: ulnar glide to increase flexion; radial glide to increase extension

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

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

Thumb metacarpal-carpal dorsal and palmar glides

Purpose: palmar glide to increase adduction; dorsal glide to increase abduction

Position: patient’s hand is positioned with the palm down, joint in a resting position; stabilizing hand grasps distal forearm with grip around trapezium while mobilizing hand grasps first metacarpal

Mobilization: with mobilizing hand, glide metacarpal toward palm to increase adduction, or toward dorsum to increase abduction while applying gentle traction[9]

MCP/IP Distraction

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.

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

[10]

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

[11]
[12]

References

  1. Powerpoint PDF Outline for Joint Mobilization of the Upper Extremity Available from:https://www.liveconferences.com/docs/jtmob.pdf (last accessed 4.4.2020)
  2. DeStefano L, Greenman P. Greenman's principles of manual medicine. Philadelphia: Lippincott Williams & Wilkins; 2011.
  3. Salter M, Cheshire L. Hand therapy. Oxford: Butterworth-Heinemann; 2000.
  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. sara asensio. Global traction of the Radiocarpal joint. Available from: https://www.youtube.com/watch?v=fruGgh6uSTM[last accessed 30/10/17]
  8. 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]
  9. 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
  10. UBCCchiro2014. 4Th- Metacarpophalangeal and Interphalangeal Joints. Available from: https://www.youtube.com/watch?v=ZFz6XnS8opY[last accessed 30/10/17]
  11. LearningMovementsUBCCchiro2014. CMC Posterior Mobilization. Available from: https://www.youtube.com/watch?v=4VPLB5fMyvQ[last accessed 30/10/17]
  12. Joint Mobilizations. MCP and IP joint mobilizations. Available from: https://www.youtube.com/watch?v=q8C0N_Fa9E0[last accessed 30/10/17]