PERIPHERAL Joint Mobilization Chapter 5 Part 4

PERIPHERAL JOINT MOBILIZATION TECHNIQUES

Wrist Complex

Wrist Complex When mobilizing the wrist, begin with general distractions and glides that include the proximal row and distal row of carpals as a group. For full ROM, individual carpal mobilizations/manipulatios may be necessary.

Radiocarpal Joint The concave distal radius articulates with the convex proximal row of carpals, which is composed of the scaphoid, lunate, and triquetrum Bones and joints of the wrist and hand

Radiocarpal Joint Resting Position The resting position is a straight line through the radius and third metacarpal with slight ulnar deviation. Treatment Plane The treatment plane is in the articulating surface of the radius perpendicular to the long axis of the radius. Stabilization Distal radius and ulna

Radiocarpal Distraction Indications Testing initial treatment pain control general mobility of the wrist Wrist joint: general distraction.

Radiocarpal Joint, General Glides, and Progression Indications Dorsal glide to increase flexion Wrist joint: general mobilization. (A) Dorsal glide

Radiocarpal Joint, General Glides, and Progression Indications volar glide to increase extension

Radiocarpal Joint, General Glides, and Progression Indications radial glide to increase ulnar deviation

Radiocarpal Joint, General Glides, and Progression Indication ulnar glide to increase radial deviation Wrist joint: general mobilization—ulnar glide.

Specific Carpal Gliding N O T E Specific techniques to mobilize individual carpal bones may be necessary to gain full ROM of the wrist Indications To increase flexion. Glide the concave radius volarly on the stabilized scaphoid. Glide the concave radius volarly on the stabilized lunate Glide the concave trapezium-trapezoid unit volarly on the stabilized scaphoid. Glide the concave lunate volarly on the stabilized capitate. Glide the concave triquetrum volarly on the stabilized hamate Specific carpal mobilizations: stabilization of the distal bone and volar glide of the proximal bone. Shown is stabilization of the scaphoid and lunate with the index fingers and a volar glide to the radius with the thumbs to increase wrist flexion

Specific Carpal Gliding Specific carpal mobilizations Indications To increase extension. Glide convex scaphoid volarly on the stabilized radius. Glide convex lunate volarly on the stabilized radius. Glide convex scaphoid volarly on the stabilized trapezium-trapezoid unit. Glide convex capitate volarly on the stabilized lunate Glide convex hamate volarly on the stabilized triquetrum stabilization of the proximal bone and volar guide of the distal bone. Shown is stabilization of the lunate with the index fingers and volar glide to the capitate with the thumbs to increase extension

Ulnar-Meniscal Triquetral Articulation Indications To unlock the articular disk, which may block motions of the wrist or forearm; apply a glide of the ulna volarly on a fixed triquetrum Self-mobilization of the ulnomeniscal-triquetral (UMI) joint

Hand and Finger Joints

Carpometacarpal and Intermetacarpal Joints of Digits II–V: Distraction Indication To increase mobility of the hand Carpometacarpal joint: distraction

Carpometacarpal and Intermetacarpal: Volar Glide Indication To increase mobility of the arch of the hand.

Carpometacarpal Joint of the Thumb

Carpometacarpal Distraction (Thumb)

Carpometacarpal Glides (Thumb) Indication Ulnar glide to increase flexion

Carpometacarpal Glides (Thumb) Indication radial glide to increase extension Radial glide to increase extension

Carpometacarpal Glides (Thumb Indication dorsal glide to increase abduction Dorsal glide to increase abduction.

Carpometacarpal Glides (Thumb) Indication volar glide to increase adduction. Volar glide to increase adduction

Metacarpophalangeal and Interphalangeal Joints of the Fingers In all cases, the distal end of the proximal articulating surface is convex, and the proximal end of the distal articulating surface is concave Resting Position The resting position is in light flexion for all joints. Treatment Plane The treatment plane is in the distal articulating surface. Stabilization Rest the forearm and hand on the treatment table; fixate the proximal articulating surface with the fingers of one hand

Metacarpophalangeal and Interphalangeal Distraction Indications Testing; Initial treatment Pain control General mobility Metacarpophalangeal joint: distraction.

Metacarpophalangeal and Interphalangeal Glides and Progression Indications Volar glide To increase flexion dorsal glide To increase extension radial or ulnar glide (depending on finger) To increase abduction or adduction Metacarpophalangeal joint: volar glide