Wrist and Hand Mobilization - An Overview

Introduction

Wrist and hand joints may rapidly fall into the possession of dysfunction after trauma, injury, assault, or overuse. And at times, the joints of the hands and wrists get locked up or stiffened. Or, in other certain instances, a malalignment or uncontrolled aspect makes the joint move in an undetermined unnatural direction. This will result in dysfunction, so the person has difficulty writing, grasping a pen, holding things, and daily functions. All these concerns are presented as pain and immobilization when a person experiences them. Therefore, one requires physical-allied intervention to unlock the joint and thus for restoration of hand and wrist function.

What Is Wrist and Hand Mobilization?

The joint mobilization technique is a form of manual therapy. The mobilization approach addresses the joint’s function, range of motion (the linear distance that an object in motion travels when attached to another), and pain. The physiotherapist implements specific passive wrist movements at varying degrees of size and speed. The movements are targeted at the joints, muscles, nerves, specific parts, and surrounding tissues of the wrist so as means to meet the restoration of ideal function.

Indication of Wrist and Hand Mobilization.

• Joint Hypomobility: Joint hypomobility refers to the joint condition where one or certain joints have an abnormally decreased range of movement. Here, the wrist joint and hand have restricted movements. Pain and stiffness of the joint are the predominant symptoms of joint hypomobility. So, joint hypomobility can be caused by several factors like surgery, arthritis, and injury.

What Are the Hand and Wrist Mobilization Techniques?

Physiotherapy professionals will design a tailored plan based on individual abilities and concerns. The therapy incorporates several sessions where the person is made to be in a comfortable, warm position granting free joint movements. Next, the therapist, with hands, gradually locates the affiliated joint and begins the mobilization by applying movements and traction ascending at levels of grades. The following are the general mobilizations of the hand and wrist, considering the parts of the arms.

Distal Radioulnar Joint Mobilization:

The therapists provide mobilization at the distal radioulnar joint with their index finger and thumb. Firstly, the therapist stabilizes the individual’s hand; then, he holds the distal ulna joint within the thumb and pad of fingers. The glide is finally given gradually. This mobilization seems effective for the overall joint play, including inward and outward movements.

Dorsal Palmer Glide at the Radiocarpal Joint:

Firstly, the therapist stabilizes the person’s elbow in a flexion manner of about 90 degrees. Then he employs a long-axis extension appropriate to the resistance and barrier. Finally, the mobilization brings about compelling wrist extension and flexion movements.

The approach is generally suggested in the case of hypermobile wrists due to long-term casting.

Radio Carpal Joint:

The therapist stabilizes the patient’s wrist in a mid-range position. Then, the force is applied gradually, covering the distal aspects. Therefore, the radial and ulnar glides are performed to enhance the deviations.

Mid-Carpal and Radiocarpal Distraction:

The mid-carpal and radiocarpal distraction encompass a similar approach, and only the position differs. As a result, both these techniques pave the way for an increase in wrist mobility. In addition, they make allowances for open spaces between joints, which in turn allows more significant movements for the wrist extension.

Mid-Carpal Dorsal-Palmer Glide:

The hand to be stabilized is positioned and held in a way to stabilize the distal aspect of the radioulnar joint. This kind of gliding approach promotes the extension ad flexion of wrists.

Thumb Metacarpal-Carpal Radial and Ulnar Glides:

The person’s hand is stabilized with the ulnar side downward while the joint is laid in the resting aspect. The therapist then stabilizes and mobilizes the hand grapes. Therefore, ulnar and radial glides are performed to enhance and increase the extension and flexion.

Thumb Metacarpal-Carpal Dorsal and Palmer Glides:

Here, the hand of the person is stabilized with the palm facing downwards and the joint at rest. Then, mobilizing glides are given towards the palm and dorsal by applying gentle traction. These glides are for the improvement of adduction and abduction. Whereas abduction is the movement of arms from the body's midline, adduction is the movement towards the midline.

How Effective Are Wrist and Hand Mobilization?

Trained, certified, experienced physiotherapy professionals implement the hand and wrist mobilization technique since it is safe and effective. The technique's predominant benefit is restoring function and motion, even as the alleviation of pain. Subsequently, the technique holds the following benefits.

• Reduces pain and discomfort concerning the wrists over time.

• Improvement in range of motion.

• Enhancement of the function in the specified wrist and arm area.

• Diminishes joint stiffness.

• Enhances movements like adduction and abduction.

• Enhances a sound joint-play.

• Kicks off a good grasping ability.

• Improvement of joint mobility and, thus, functionality.

• Diminishes muscle spasms and muscle tension.

• Restores optimal motion.

• Therefore, it improves the quality of life.

What Are the Contraindications of Hand and Wrist Mobilization?

Wrists and hand mobilization primarily and effectively restore the actual range of motion and hand function. However, the wrists and hand mobilization are contraindicated in the following aspects.

• Unstable joint.

• Healing fracture involving the joint or adjacent sites.

• Acute inflammation.

• Bony diseases.

• Tumor.

• Osteoporosis.

• Joint hypermobility.

• Joint ankylosis.

• Malignancy.

• Paget’s disease.

• Nerve root compression.

Subsequently, specific considerations should be taken into account for the following elements.

• Restoration of the thumb, along with its function, range of motion, and position, require prompt and urgent attention. So, the thumb must be considered first.

• In addition, the person’s way of daily living, functions, occupational activities, physical performances, and leisure is to be taken into account.

• It is essential to enhance and improve the movements, such as pinch grip, grasp, and flexion of fingers, before the extension enhancement.

• The joint mobilization in conjugation with thermal ultrasound is to be considered in people after traumatic injury or surgery, as they seem compelling.

Conclusion:

According to the studies and documentation, wrist and hand mobilization is an effective passive-allied manual therapy. The professionals implement the intervention only after being determined by exhaustive evaluation that the mobilization is indicated or required. In addition, the therapist adds the technique with the combination of the active rehabilitation plan. So, one can get sound, safe, and restoration effects with hand and wrist mobilization.