Wrist Manipulation

Patient and Practitioner set-up

1. The patient can be sitting or standing.

Passive Motion Assessment

• Arthrokinematic motion of any of the carpal bones can be assessed using posterior-to-anterior (PA) or anterior-to-posterior (AP) mobilizations.

Lockout Position:

1. The practitioner is going to wrap both hands around the patient's wrist and hands.
2. The thumbs should be in position to apply pressure to the dorsal surface of the wrist, and the sides of the index fingers in position to apply pressure to the palmar surface of the wrist.

• For increasing wrist extension:
  • The practitioner will place one thumb over the other to apply a dorsal to palmar force to the bone the practitioner would like to manipulate.
  • The practitioner will then find the end-range palmar motion of that bone.
  • Maintaining the palmar position of that bone, the practitioner will passively extend the patient's wrist to end-range to achieve lock-out.
• For increasing wrist flexion:
  • The practitioner will use the proximal or distal interphalangeal joint (IP) of one index finger to apply a palmar to dorsal force to the bone the practitioner would like to manipulate.
  • The practitioner will then find the end-range dorsal motion of that bone.
  • Maintaining the dorsal position of that bone, the practitioner will passively flex the patient's wrist to end-range to achieve lock-out.

High-Velocity Thrust

Important Note: 90% of the manipulation technique is set-up. If you have not achieved lock-out in the previous steps, having great "thrust technique" will be rendered useless.

1. The high-velocity portion of this technique is just a quick whip into the motions used to achieve lock-out.
2. Once the "lock-out" position is identified, a small whip-like motion with the intent to move just past the lock-out position should result in a successful manipulation
   • The wrist (like the elbow) is NOT a stubborn or inherently stiff joint. This manipulation requires speed and accuracy, but not a large amount of force or pressure. If you are tempted to use more force, first start by trying to increase your speed, and if that does not result in a successful manipulation, then start the technique over. Also, remember that cavitation is not necessary for a successful manipulation. Success is an increase in arthrokinematic motion and a measurable change in ROM.