1. PERIPHERAL Joint Mobilization
Chapter 5
Part 4

2. PERIPHERAL JOINT MOBILIZATION TECHNIQUES

3. Wrist Complex

4. 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.

5. 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

6. 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

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

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

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

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

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

12. 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

13. 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

14. 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

15. Hand and Finger Joints

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

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

18. Carpometacarpal Joint of the Thumb

19. Carpometacarpal Distraction (Thumb)

20. Carpometacarpal Glides (Thumb)
Indication
Ulnar glide to increase flexion

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

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

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

24. 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

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

26. 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