JOINT MOBILIZATION OF THE WRIST AND THE HAND. PART 2

Cập nhật lần cuối vào 24/11/2022

Kỹ thuật di động khớp cổ tay và bàn tay, phần 2: các khớp cổ bàn tay (CMC), bàn ngón tay (MCP) và liên ngón tay (IP).

ANATOMY REVIEW

Bones and Joints

Từ vựng:

• Radius: xương quay
• Ulna: Xương trụ
• Ulnar styloid: mỏm trâm trụ
• Carpals: Các xương cổ tay (gồm hai hàng, thuyền nguyệt tháp đậu/thang thê cả móc)
• Metacarpals: Các xương bàn
• Phalangges: Các xương ngón tay
• Radioulnar joint: khớp quay trụ
• Radiocarpal joint: khớp quay cổ tay
• Intercarpal joint: khớp gian cổ tay
• CMC: khớp cổ bàn tay
• MCP: khớp bàn ngón tay
• PIP: khớp liên ngón ngón gần
• DIP: khớp liên ngón xa

Physiologic (Osteokinematic) Motions of the Wrist and Hand

Các vận động sinh lý (chuyển động học xương) của cổ và bàn tay

Từ vựng:

• Flex: Flexion/ gấp
• Ext: Extension/duỗi
• Add: Adduction, khép ( =nghiêng trụ với cổ tay)
• Abd: Abduction, dạng (= nghiêng quay với cổ tay)
• Supination: quay ngửa
• Pronation: quay sấp
• Volar: mặt lòng, mặt bụng
• Dorsal: mặt mu, mặt lưng
• Distal: đầu xa, đầu dưới
• Proximal: đầu gần, đầu trên
• End feel: cảm giác cuối tầm (của khớp)

Accessory (Arthrokinematic) Motions of the Wrist and Hand

Các vận động phụ trợ (chuyển động học khớp) của cổ và bàn tay

Notes/Ghi chú:

• Physiologic Motions: vận động sinh lý, chuyển động xương
• Accessory Motions: vận động phụ trợ, chuyển động học khớp, joint play
• OPP: Open Packed Position/ Tư thế khớp mở = resting position, tư thế khớp nghỉ: là tư thế thường dùng bắt đầu để di động khớp. Ghi nhớ quy luật mặt lồi/lõm
• CPP: Closed Packed Position/ Tư thế khớp khoá
• OKC: open Kinetic Chain: Chuỗi động mở: Kỹ thuật di động khớp thường dùng ở chuỗi động mở để khu trú lên khớp được thực hiện
• Concave: lõm
• Convex: lồi
• Glide: trượt
• Distraction: kéo tách
• Trong kỹ thuật, kỹ thuật viên thực hiện cố định đầu gần/phần xương cố định: Dấu chéo đỏ
• Kỹ thuật viên thực hiện vận động phụ trợ: Mũi tên xanh
• Người bệnh có thể thực hiện vận động sinh lý phối hợp: Mũi tên vàng

XEM THÊM: GIẢI PHẪU CHỨC NĂNG PHỨC HỢP CỔ BÀN TAY. XƯƠNG VÀ KHỚP

CARPOMETACARPAL (CMC) JOINT MOBILIZATIONS

Carpometacarpal Distraction and Glide

Indications:

• Distractions  to improve mobility in all directions.
• At the first CMC joint, glides toward palm of hand  to improve abduction, and glides away from the palm  to improve adduction.
• Lateral glides of the first CMC joint  to improve extension, and medial glides  to improve flexion.
• For second to fifth CMC joint, glides toward the palm of hand  to improve flexion and glides away from the palm  to improve extension.

Accessory Motion Technique

• Patient Position: sitting position with the forearm fully pronated and the palm facing downward. You may pre-position the hand with the joint at the point of restriction.
• Clinician Position  & Hand Placement: 
  • Sit on the ipsilateral side of the hand being mobilized.
  • Stabilization hand: Grasp the distal row carpal bone between the finger and thumb 
  • Mobilization hand: grasp the base of the metacarpal immediately adjacent to the stabilizing hand.
• Force Application: Take up the slack in the joint and apply force in the direction of the long axis of the metacarpal. 
  • For volar glides, apply downward force. 
  • For dorsal glides, apply upward force.

Accessory With Physiologic Motion Technique

• Patient Position: the same position as described above.
• Clinician Position  & Hand Placement: the same as described above.
• Force Application: As the patient actively performs CMC flexion, extension, abduction, and adduction, distraction or glide of the joint is maintained throughout the entire range of motion and sustained at end range. Adjust the direction of force to remain in line with the long axis of the phalanx.

METACARPOPHALANGEAL (MCP) JOINT MOBILIZATIONS

Metacarpophalangeal Distraction

Indications:

• To improve mobility in all directions.

Accessory Motion Technique

• Patient Position: sitting position with the forearm fully pronated and the palm facing downward. The MCP joint is in 20 degrees of flexion. You may pre-position the hand with the joint at the point of restriction. .
• Clinician Position  & Hand Placement: 
  • Sit on the ipsilateral side of the hand being mobilized
  • Stabilization hand: Grasp the metacarpal head between the thumb and index finger
  • Mobilization hand: Grasp the proximal phalanx immediately adjacent to the stabilization hand using a hook grasp or pinch grasp.
• Force Application: Take up the slack in the joint and apply force in the direction of the long axis of the phalanx.

Accessory With Physiologic Motion Technique

• Patient Position: the same position as described above.
• Clinician Position  & Hand Placement: the same as described above.
• Force Application: As the patient actively performs MCP flexion and extension, apply distraction that is maintained throughout the entire range of motion and sustained at end range. Adjust the direction of force to remain in line with the long axis of the phalanx.

Metacarpophalangeal Dorsal and Volar Glide

Indications:

• Metacarpophalangeal dorsal glides: To improve  MCP extension.
• Metacarpophalangeal volar glides: To improve  MCP flexion.

Accessory Motion Technique

• Patient Position: sitting position with the forearm fully pronated and the palm facing downward. The MCP joint is in 20 degrees of flexion. You may pre-position the hand with the joint at the point of restriction.
• Clinician Position  & Hand Placement: 
  • Sit on the ipsilateral side of the hand being mobilized.
  • Stabilization hand: grasp the metacarpal head between the thumb and index finger.
  • Mobilization hand: Grasp the base of the proximal phalanx immediately adjacent to the stabilization hand.
• Force Application: Take up the slack in the joint and apply force in a downward direction for volar glides and an upward direction for dorsal glides.

Accessory With Physiologic Motion Technique

• Patient Position: in the same position as described above.
• Clinician Position  & Hand Placement: the same as described above.
• Force Application: As the patient actively performs MCP flexion and extension, apply volar and dorsal glides that are maintained throughout the range of motion and sustained at end range. Adjust the direction of force to ensure proper force application.

Metacarpophalangeal Medial and Lateral Glide

Indications:

• Metacarpophalangeal medial glides to improve  MCP abduction. 
• Metacarpophalangeal lateral glides to improve  MCP adduction.

Accessory Motion Technique

• Patient Position: sitting position with the forearm fully pronated and the palm facing downward. The MCP joint is in 20 degrees of flexion. You may pre-position the hand with the joint at the point of restriction.
• Clinician Position  & Hand Placement: 
  • Sit on the ipsilateral side of the hand being mobilized.
  • Stabilization hand: grasp the metacarpal head between the thumb and index finger. 
  • Mobilization hand: Grasp the base of the proximal phalanx immediately adjacent to the stabilization hand.
• Force Application: Apply force in a medial and lateral direction as indicated.

Accessory With Physiologic Motion Technique

• Patient Position: the same position as described above.
• Clinician Position  & Hand Placement: the same as described above.
• Force Application: As the patient actively performs MCP flexion and extension, lateral and medial glides are maintained throughout the range of motion and sustained at end range.

PROXIMAL/DISTAL INTERPHALANGEAL (IP) JOINT MOBILIZATIONS

Proximal/Distal Interphalangeal Distraction

Indications:

• To improve  mobility in all directions.

Accessory Motion Technique

• Patient Position: sitting position with the forearm fully pronated and the palm facing downward. The IP joint is in 20 degrees of flexion. You may pre-position the hand with the joint at the point of restriction.
• Clinician Position  & Hand Placement: 
  • Sit on the ipsilateral side of the hand being mobilized.
  • Stabilization hand: grasp the proximal phalanx between the thumb and index finger. 
  • Mobilization hand: Contact the base of the distal phalanx immediately adjacent to the stabilization hand using a hook or pinch grasp.
• Force Application: Apply force in the direction of the long axis of the phalanx.

Accessory With Physiologic Motion Technique

• Patient Position: the same position as described above.
• Clinician Position  & Hand Placement: the same as that described above.
• Force Application: As the patient actively performs IP flexion and extension, distraction is maintained throughout the entire range of motion and sustained at end range. Adjust the direction of force to ensure proper force application.

Proximal/Distal Interphalangeal Dorsal and Volar Glide

Indications:

• To improve IP extension and flexion, respectively.

Accessory Motion Technique

• Patient Position: sitting position with the forearm fully pronated and the palm facing downward. The IP joint is in 20 degrees of flexion. You may pre-position the hand with the joint at the point of restriction.
• Clinician Position  & Hand Placement: 
  • Sit on the ipsilateral side of the hand being mobilized.
  • Stabilization hand: grasp the proximal phalanx between the thumb and index finger. 
  • Mobilization hand: Grasp the distal phalanx immediately adjacent to the stabilization hand.
• Force Application: Apply force in an upward or downward direction for dorsal and volar glides, respectively.

Accessory With Physiologic Motion Technique

• Patient Position: the same position as described above.
• Clinician Position  & Hand Placement: the same as described above.
• Force Application: As patient actively performs IP flexion and extension, glide is maintained throughout the entire range of motion and sustained at end range.

References:

• Christopher H. Wise, Dawn T. Gulick. Mobilization Notes: Rehabilitation Specialist’s Pocket Guide. F. A. Davis Company, 2009.
• Christopher H. Wise. Orthopaedic Manual Physical Therapy: FROM ART TO EVIDENCE. F. A. Davis Company. 2015.
• Carolyn Kisner, Lynn Allen Colby, John Borstad. Therapeutic exercise : foundations and techniques, Seventh edition. F.A. Davis Company. 2018