Name: Wrist Manipulation
Uploaded: 2023-04-23T07:03:30.000Z
Duration: 8 min 24 s
Description: Learn the proper technique for wrist manipulation in this instructional video designed for clinicians and movement professionals. This manual joint mobilization may assist in reducing wrist pain, improving range of motion, enhancing flexibility, and supporting functional performance in athletic and daily activities.

English captions

https://stream.mux.com/fT00mhhYZVemlDvrAEUq1C023019VwE49SPcjOipzcFnHc.m3u8

Learn the proper technique for wrist manipulation in this instructional video designed for clinicians and movement professionals. This manual joint mobilization may assist in reducing wrist pain, improving range of motion, enhancing flexibility, and supporting functional performance in athletic and daily activities.

Introduction to High Velocity Thrust Techniques

Carpal Manipulation Techniques Explained

Identifying Stiffness in Carpal Bones

Demonstrating the Manipulation Process

Recap and Best Practices for Manual Techniques

Wrist Manipulation

This is Brenda. The Brooke Bush Institute in this video. We're gonna go over manipulations or High Velocity thrust techniques. I assume that if you're watching this video you're watching it for educational purposes and that you are a licensed professional with high velocity thrust or manipulation techniques in your scope of practice. If you're not sure check with your state board most physical therapists chiropractors and osteopaths, you're in the clear. I believe that atc's you can't do manipulations in the United States, although other countries again, check your scope, of course massage therapists and personal trainers. These are generally not within your scope. Of course, you could continue to watch these videos just for educational purposes. Learn a little Anatomy learn a little biomechanics. If you're going to do these techniques, please make sure that you have a good rationale for putting your hands on a patient. This should be based on assessment and if you're going to assess I'm hoping that you'll assess use these interventions. And reassess to ensure that you're getting the result that you're looking for and have good reason to continue using this technique in this video. We're going to go over carpal manipulation. I'm gonna have my friend a vet come out. She's gonna help me demonstrate and keep in mind if we're doing manipulations. They're always based on subjective and objective measures in this case. Maybe we would be looking at pronation supination flexion and extension of the wrist, right? We could try some ganiometry for flexion and extension of the wrist. It's questionably reliable and I think you guys gonna find this technique is actually super simple and kind of fun. So go ahead. Let's do your your left wrist. There we go. So what you guys are going to do is you're going to palpate. to the end of the radius and ulna now at the end of the radius and Ulta you guys know you have a proximal and distal row of carpal bones. Now, we could go through all of these different bones and all that fun stuff, but we actually don't have to for this technique really all you need to do is you can guys can do like posterior anterior kind of Glides to check passive accessory motion. You could even kind of keep your hands. thumbs on the rows and kind of test flexion and extension and feel like See if any of the bones feel stuck to you. And you can kind of just move over. In a Real segmental Fashion. Remember these bones are pretty small. So As you're moving through good. Okay. Well now you found something that you think is stiff. Once you find something that you think is kind of stiff. maybe I think right there stiff, right? What we're gonna do is we've got to lock out this joint. So, how are we gonna lock out this joint? We're gonna pull a little bit into traction. I'm gonna pull to the end of extension now as I'm pulling to the end of extension. What I'm doing is I'm actually applying a what are we gonna call this a volar to Palmar There you go. Look those words up. All right Force, right. So we're going from the back of the hand to the front of the hand Force this way. So I'm pushing down with my thumb as I pull into extension once I have our lockout. I'm now going to do that ever so fun whip. Alright, so we get her here and then And boom we got a nice little cavitation, right? And then if I wanted to I can move over. And right there. And boom we got another one then I can move over again. And we got another one isn't that great. Now the thing that people forget is you don't have to just go into extension. If I feel like there's stiffness into flexion. I can now go opposite this gets a little tricky. I tend to use like this knuckle right here. kind of palpate the bones from underneath And then once I get good. Purchase, I'm just going to go. A whip into flexion right you okay my pension, I'll try not to pinch. All right, so it's probably better guys as I'm taking my thumbs here. I'm the mistake I made on the first one is I had my thumbs a little too high. So I was pushing into a lot of soft tissue pushing that soft tissue into these tiny little bones if I cross my thumbs over her metacarpals. It's a little less Pinchy. I'll try to get a little lower here too ready. That's it. So there you guys had it these These manipulations are super simple. I'll go ahead and do a close-up recap for you guys. So you can see how my thumbs are moving across but essentially again, you're going this way when you're going to extension and it's a whip and you're gonna push this way and pull into a flexion when you do a whip this way. Stay tuned for your closest recap. So I just wanted to show you guys a little closer on what I'm palpating. So if I come to the end of my radius and ulna I'll feel my little carpal bones which feel like little Pebbles right and as I move them from. dorsal to volar my mistake in the previous video for saying volar and Palmar as opposites. Those are synonyms. So don't dorsal to Palmar or volar. I can kind of see if there's stiffness and I feel a little bit of stiffness right here now once I feel stiffness, I'm just going to go kind of thumb over thumb. I'm gonna pull the end range extension, right? So you guys can see here. This is what I'm doing with my other fingers. All right, and then once I get to end range, I just give it a little. Bit, that's it. All right, real easy. I can move to the next segment over. All right, so that if I was here which might be your handmade and then I can move over here. And I can pull all the way down. And do it again. All right, if I wanted to go more medial I could do that. Right thumb over thumb. and If I want to go into flexion work on maybe flexion range of motion, I could do that. I could then go from Palmar to Dorsal. right, see if I feel any stiffness that way now this time I'm going to use more like this part of my my fingers here. To kind of push up this way. All right, so Getting too mean two of that's hand here. I'm just pushing up this way guys. Right kind of using my knuckle as my fulcrum. And then I can pull all the way into flexion. And then just a little whip. All right. So there you guys have it give those a little experimentation with friends and colleagues first. And then of course, you can try them with patience. If you have any questions leave them in the comments box below a couple of points to recap knowing your anatomy and knowing your biomechanics will certainly help you choose the right technique for the right patient. If you're unsure whether manipulations are appropriate due to their higher intensity. It's okay to do mobilizations most research points to manipulations being slightly more effective, but mobilizations being very effective. And of course, we have those videos for you. If you want to start with those less intense techniques make sure that if you are doing any technique that is based on assessment and of course that you're reassessing ensuring that the technique is effective for the patient that you're working on and when it comes to all manual techniques guys manipulations, maybe more than any other look for opportunities to get live education, although I know videos are convenient and I'm happy to have these up for you guys to watch it would be so much more helpful to use those videos as a recap. Of one-on-one attention with somebody who's experienced with manipulation techniques at the very least grab a colleague grab a friend and start practicing these before you bring them into clinic and start using them on patients and clients. I hope you enjoyed this video. If you have any questions, please leave them in the comments box below.

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Joint manipulations for the wrist and elbow. Types of manipulations, manipulations vs. mobilizations of the wrist and elbow. Optimal intervention for elbow pain, lateral epicondylitis (epicondylalgia), wrist pain, and carpal tunnel syndrome. The risk of adverse events, accuracy vs sensitivity, screening, reliability, and validity of wrist and elbow manips.

Joint Manipulation: Elbow (Radial Head) and Wrist

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

The practitioner is going to wrap both hands around the patient's wrist and hands.

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.

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.

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.

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.

The high-velocity portion of this technique is just a quick whip into the motions used to achieve lock-out.

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.

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