Wrist Carpal Transarticular Distraction Mobilization

Physical Therapy First demonstration of Wrist Carpal Transarticular Distraction Mobilization

🧾 What you’ll see
Setup — Patient seated with forearm supported (table/bolster). Elbow ~70–90° flexed, forearm neutral to slight pronation. Therapist sits facing the patient. One hand stabilizes the distal radius/ulna just proximal to the radiocarpal joint (broad contact). The mobilizing hand grips the proximal carpal row (just distal to the radiocarpal crease) with a snug “C-grip.” Patient relaxes fingers/hand.
Mobilization — With the forearm firmly stabilized, apply a long-axis distraction of the carpus relative to the radius/ulna. Start with gentle Grade I–II oscillations to reduce pain/muscle guarding; progress to Grade III (Maitland) or Kaltenborn II–III sustained holds to address capsular restriction, staying strictly within patient tolerance. Keep the traction vector colinear with the forearm, forearms stacked, shoulders relaxed.
Reset — Release traction slowly, reassess active wrist motion and symptoms, and repeat if indicated.

🎯 Coaching cues (for clinicians)

“Lock the forearm” — firm, comfortable stabilization of radius/ulna prevents shear.

“Traction from the carpus” — grip just distal to the crease; don’t pull from the metacarpals.

“Line of drive” — traction in the long axis; avoid ulnar/radial deviation unless testing coupled motion.

“Dose to tissue feel” — ease in, find the first resistance (R1), oscillate or hold; never force past protective spasm.

“Re-test” — check pain, end-feel, and AROM after each bout.

💪 Why it helps

Decompresses the radiocarpal joint, modulating nociception and easing capsular tightness.

Improves joint play needed for efficient wrist flexion/extension and weight-bearing tolerance (e.g., push-ups, yoga, gripping tasks).

Useful after immobilization, with post-sprain stiffness, or in overuse presentations where the capsule is guarded but clinically stable.

📋 Step-by-step

Position patient and support the forearm; ensure full relaxation.

Stabilize distal radius/ulna; mobilizing hand “C-grips” the proximal carpus.

Take up slack to the first tissue stop; apply gentle oscillatory distraction (I–II) for pain relief.

If tolerated and indicated, progress to larger-amplitude oscillations (III) or Kaltenborn sustained holds (II–III) to lengthen the capsule.

Release slowly; reassess pain and range. Repeat 2–3 bouts as needed.

⏱️ Dosage (typical)

Pain modulation: Maitland Grade I–II, 30–60s oscillations, 1–3 bouts.

Mobility gain: Maitland Grade III oscillations or Kaltenborn II–III sustained holds of 10–30s, 2–3 bouts with reassessment between.

Frequency: integrate within treatment sessions 2–3×/week, paired with active mobility/grip retraining.

⚡ Progressions / Variations

Belt-assist to maintain steady traction while freeing a hand for accessory glides.

Add gentle posterior/anterior carpal bias once distraction is tolerated.

Follow with AROM (pain-free), tendon glides, light grip, or closed-chain loading dose.

⬇️ Regressions

Reduce amplitude to Grade I only; shorten hold times.

Position with greater forearm support or slight wrist flexion/neutral to enhance comfort.

Begin with soft-tissue and edema management before joint mobilization if guarding is high.

❌ Common errors

Inadequate forearm stabilization causing shear or patient guarding.

Pulling from the metacarpals instead of the carpus.

Off-axis traction (drifting into deviation) that irritates periarticular tissues.

Overdosing intensity or duration without frequent reassessment.

🚫 Contraindications & precautions

Suspected/confirmed fracture, acute ligament rupture (e.g., scapholunate), carpal instability, post-op precautions without clearance.

Inflammatory arthropathies in acute flare, severe osteoporosis, infection, open wounds.

Neurologic/vascular compromise (new numbness, color change)—stop and reassess.

🧰 Equipment
Treatment table/bolster; optional mobilization belt; gloves as needed.

🚨 Disclaimer
This video and the exercises shown are for general educational purposes only and are not a substitute for individualized evaluation, diagnosis, or treatment. Before performing any exercise, you agree to:

Consult with a qualified provider if you have or suspect an injury or medical condition.

Assume all risks associated with exercising.

Understand that viewing this video does not create a therapist–patient relationship with Physical Therapy First.
Stop immediately and seek professional advice if you experience sharp pain, numbness/tingling, dizziness, or shortness of breath.


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