Wrist, Forearm and Finger Mobilization-Case Studies

W. Smith DPT. ATC , SCS , CMT

Wrist Colles’ Fracture

Colles’ fracture 1. 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.

2. Complications from a Colles’ fracture can include injury to the distal radioulnar joint and the distal radiocarpal joint.

Colles’ Fracture- Case I

History 18 year old skateboarder sustained a colles’ fracture of the right wrist.

Clinical Findings Functional losses to the patient include limited range of

motion in all planes of wrist movement: a. Flexion/extension. b. Radial/ulnar deviation. c. Pronation/supination.

Pain is intermittent rated 4/10

Arthokinematic of the Wrist

It believed that most wrist motion occurs between the radiocarpal, ulnacarpal and midcarpal rows.

Proximal articulation of the convex scaphoid, lunate and triquetrium move on concave radius.

Dorsal glides of the scaphoid, lunate and triquetrium will enhance flexion of the wrist.

Arthokinematic of the Wrist

Volar glide of scaphoid, lunate and triquetrium will help to restore extension.

Radial deviation occurs in conjunction with wrist extension.

Ulnar deviation occurs in conjunction with wrist flexion.

Wrist Bone Anatomy

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Mobilization Techniques for the Wrist

Wrist distractionWrist dorsal and volar glidesDorsal and volar glides of selected carpal

bones.Radial and ulnar glides of the wrist.

Wrist Distraction

To increase joint play in the radiocarpal and ulnocarpal joints

To decrease pain Generally first

mobilization treatment

Wrist Dorsal Glide

Purposes are the same as for distraction, with emphasis on restoring wrist flexion.

Dorsal Glide of the Capitae on Lunate

Helps restore wrist flexion.

Wrist Ventral (Volar) Glide

To increase overall movement of the proximal row of carpal bones on the radius and ulna.

To improve overall wrist extension.

Volar Glide of Scaphoid on Radius

To Improve Extension of the wrist.

Triquetrium-Ulna Glide

To restore wrist extension

To release a fixated triquetal-ulnar disc.

Wrist Ulnar Glide

General Mobilization to restore radial deviation and wrist flexion.

Wrist Radial glide

General Mobilization to restore ulna deviation and wrist extension

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Volar and Dorsal Glide of the Radio-Ulnar Joint

Volar Glide restores PronationDorsal Glide restores Supination

Metacarophalangel Mobilization Techniques

Selected Conditions

Finger Injuries

Treating joint restriction can be a challenge due to: Effects of swelling on the small joints

(fibrosis) Small lever arm

Finger Injuries

Distal phalanx Avulsions

Terminal extensor with tight repair

Treatment: MP distraction and dorsal glide

MP,PIP DIP Volar Glides

To improve flexion of the digits

Finger Fractures

Finger Fractures adhesion due to splintered fracture and division

of extensor hood for visualization of the fracture

Treatment: Dorsal/palmar glides Middle phalanx Very rare due to thick cortex of shaft

Proximal Phalanx Many are spiral fractures that require fixation Joint fibrosis due to swelling/immobilization Tendon

End