Wrist Hand Presentation

1. Wrist, Forearm and Finger
Mobilization-Case Studies
W. Smith DPT. ATC , SCS , CMT

2. Wrist Colles’ Fracture
z Colles’ fracture
z1. Classified as an extra-articular fracture of the distal
radius with dorsal (posterior) displacement of the distal
radius and a radial shift of the wrist carpals and hand.
z2. Complications from a Colles’ fracture can include
injury to the distal radioulnar joint and the distal
radiocarpal joint.

3. Colles’ Fracture- Case I
zHistory 18 year old skateboarder sustained a colles’
fracture of the right wrist.
zClinical Findings
z Functional losses to the patient include limited range of
motion in all planes of wrist movement:
ya. Flexion/extension.
yb. Radial/ulnar deviation.
yc. Pronation/supination.
zPain is intermittent rated 4/10

4. Arthokinematic of the Wrist
zIt believed that most wrist motion occurs
between the radiocarpal, ulnacarpal and
midcarpal rows.
zProximal articulation of the convex
scaphoid, lunate and triquetrium move on
concave radius.
zDorsal glides of the scaphoid, lunate and
triquetrium will enhance flexion of the wrist.

5. Arthokinematic of the Wrist
zVolar glide of scaphoid, lunate and
triquetrium will help to restore extension.
zRadial deviation occurs in conjunction
with wrist extension.
zUlnar deviation occurs in conjunction with
z wrist flexion.

6. Wrist Bone Anatomy
QuickTimeª and a
Planar RGB decompressor
are needed to see this picture.

7. Mobilization Techniques
for the Wrist
zWrist distraction
zWrist dorsal and volar glides
zDorsal and volar glides of selected carpal
bones.
zRadial and ulnar glides of the wrist.

8. Wrist Distraction
zTo increase joint play
in the radiocarpal and
ulnocarpal joints
zTo decrease pain
zGenerally first
mobilization treatment

9. Wrist Dorsal Glide
zPurposes are the
same as for
distraction, with
emphasis on
restoring wrist flexion.

10. Dorsal Glide of the Capitae
on Lunate
zHelps restore wrist
flexion.

11. Wrist Ventral (Volar) Glide
zTo increase overall
movement of the
proximal row of carpal
bones on the radius
and ulna.
zTo improve overall
wrist extension.

12. Volar Glide of Scaphoid
on Radius
zTo Improve Extension
of the wrist.

13. Triquetrium-Ulna Glide
zTo restore wrist
extension
zTo release a fixated
triquetal-ulnar disc.

14. Wrist Ulnar Glide
zGeneral Mobilization
to restore radial
deviation and wrist
flexion.

15. Wrist Radial glide
zGeneral Mobilization
to restore ulna
deviation and wrist
extension
QuickTimeª and a
Planar RGB decompressor
are needed to see this picture.

16. Volar and Dorsal Glide of the
Radio-Ulnar Joint
zVolar Glide restores Pronation
zDorsal Glide restores Supination

17. Metacarophalangel
Mobilization Techniques
Selected Conditions

18. Finger Injuries
zTreating joint restriction can be a
challenge due to:
yEffects of swelling on the small joints
(fibrosis)
ySmall lever arm

19. Finger Injuries
zDistal phalanx
y Avulsions
xTerminal extensor with
tight repair
yTreatment: MP
distraction and dorsal
glide

20. MP,PIP DIP Volar Glides
zTo improve flexion of
the digits

21. Finger Fractures

22. Finger Fractures
yadhesion due to splintered fracture and division
of extensor hood for visualization of the fracture
zTreatment: Dorsal/palmar glides Middle
phalanx
yVery rare due to thick cortex of shaft
zProximal Phalanx
yMany are spiral fractures that require fixation
yJoint fibrosis due to swelling/immobilization
yTendon

23. End