Wrist & Hand - Mobilisations & Adjustments 1

Question 1

Wrist: Supine, Overhead I Traction and Circumduction
Patient Position?
Practitioner Position?
Contacts?
Pre-Adjustment Position?
Adjustment?

Answer 1

Patient Position - Arm fully extended and pronated. Shoulder flexed to 135 degrees
Practitioner Position - Homolateral side in line with patient’s shoulders facing cephalad
Contacts - Web contacts underneath the scaphoid and pisiform with thumbs crossing over the palmar surface and fingers wrap around the dorsum of the wrist applying knife edge
Pre-Adjustment Position - Fencer’s stance apply body weight cephalad to create traction
Adjustment - Circumduction a number of times both ways

Question 2

Wrist: Supine, Pronated I Traction and Circumduction
Patient Position?
Practitioner Position?
Contacts?
Pre-Adjustment Position?
Adjustment?

Answer 2

Patient Position - Supine, homolateral, arm pronated
Practitioner Position - Facing cephalad in line with patient’s hips/thighs
Contacts - Thenar contact over metacarpals. Crooked index on the underside
Pre-Adjustment Position - Skiier’s stance, slight traction to extend elbow
Adjustment - Internal circumduction of wrist and shoulder. Get low

Question 3

Wrist: Supine, Semi-Supinated I Traction and Circumduction
Patient Position?
Practitioner Position?
Contacts?
Pre-Adjustment Position?
Adjustment?

Answer 3

Patient Position - Supine, homolateral, semi supination
Practitioner Position - In line with patient’s hips/thighs facing cephalad
Contacts - With caudal hand thumb over scaphoid, middle finger underneath pisiform. With other hand interlock fingers underneath and cross thumbs
Pre-Adjustment Position - Slight traction to extend elbow
Adjustment - Internal circumduction of wrist and shouer

Question 4

Wrist: Supine, Pronated I Traction and Cylindrical Rotation
Patient Position?
Practitioner Position?
Primary Contact?
Secondary Contact?
Adjustment?

Answer 4

Patient Position - Supine, forearm pronated and against couch, contralateral side
Practitioner Position - Homolateral side
Primary Contact - Thumb and middle finger over radiocarpal joint
Secondary Contact - Adjacent and squeeze index fingers in to create traction
Adjustment - Cylindrical rotation both directions

Question 5

Wrist: Supine, Pronated I Longitudinal Thenar Kneading
Patient Position?
Practitioner Position?
Primary Contact?
Secondary Contact?
Adjustment?

Answer 5

Patient Position - Supine forearm pronated, contralateral side
Practitioner Position - Homolateral side, facing caudal
Primary Contact - Thenar pad and crooked index over the radius
Secondary Contact - Thenar pad and crooked index over ulna
Adjustment - P-A, A-P glide. Move superiorly 1cm and apply again. Must stop 1/3 way due to radius crossing ulna

Question 6

Phalanx: Traction / Cylindrical Rotation
Patient Position?
Practitioner Position?
Contacts
Pre-Adjustment Position?
Adjustment?

Answer 6

Patient Position - Supine. Humerus rests on couch while pronated forearm raised
Practitioner Position - Homolateral side facing transverse
Contacts - Thumb and crooked index either side of joint line being tested (MCP, PIP or DIP of digits 2-5)
Pre-Adjustment Position - Slight traction
Adjustment - Maintain traction and apply cylindrical rotation then alternate direction