Wrist Stiffness, Simplified

Chapters

• 0:00 Humor, Host, And Credentials
• 0:26 Why Wrists Get Stiff
• 0:51 Safety First And Setup
• 1:07 Forearm Anatomy And Rotation Basics
• 2:24 Assisted Supination Techniques
• 3:52 Assisted Pronation Techniques
• 4:44 Wrist Flexion Methods
• 5:27 Wrist Extension Methods
• 6:19 Finger Tendon Tightness And Fixes
• 7:31 Clinic-Only Manual Therapy Advantages
• 8:31 Wrap-Up And Calls To Action

Transcript

SPEAKER_00: 0:01

Welcome back to the hand-to-shoulder solution, giving pain the middle finger. You know, patients love that. Giving pain the middle finger, that really uh breaks the ice, it gets people laughing. I like to use humor in the clinic, it uh really puts people at ease. I'm your host, Carl Petito. I'm an occupational therapist and a board certified hand therapist. I specialize in the rehabilitation of orthopedic conditions affecting the fingertips through the shoulder. So let's talk about wrist stiffness. And quick disclaimer: this is not medical treatment or advice. Uh, it's really important to find out why your wrist is stiff. It's crucial to be seen by your healthcare practitioner to rule out uh very serious problems and make sure everything is structured structurally sound before you start doing any stretches. And I want to share with you stretches that I show my patients, and my patients can reference this also. In the clinic, I usually do a video on their smart telephone of them doing the exercises so they can reference that later. That's very helpful as well. So the stiff wrist, a lot of reasons could be perhaps you just got out of a cast or you just had surgery for a distal radius fracture, for example. Uh fall on an outstretched hand is very common, and this breaks right here. Then a plate and screws, if it's a displaced or shifted fracture, are applied in order to reconstruct the bone. We get those moving within about a week after surgery. I fabricate a custom molded brace to support the fracture to be worn between light exercise sessions and during sleeping hours. But today let's go over some very basic stretching techniques because it is crucial to regain motion for function, otherwise, you're gonna have a really hard time using your hand. The forearm has to turn palm up, and that's a forearm motion. So right here it's palm down. The radius is crossed over the ulna. So the tip of your elbow is your ulna, and then when you turn it palm up, the radius is now parallel with the ulna. It's the forearm joint that turns it palm up and palm down. So, how do we restore flexibility and get that moving again? So that's done with the opposite hand in a clamp grip, getting up in here at the end of the forearm right here, and turning that palm up until you feel a stretch, holding that for 20 seconds, and then letting go for an active hold, and that hold retrains the muscle so your motion, your independent motion, will match your flexibility as flexibility is gained. Another technique I have people do in addition to this is to get the tip of the thumb and what we call the theonar eminence, it's a group of muscles. This wrist, even though there's a lot of bones in there, how many bones make up the wrist? 15. So you have the radius anoma, the acarpels, and the five metacarpels right here. In this region, right here, there's 15 bones. There is a complex series of ligaments that make this very stable, very solid. And this, when we're regaining motion, we're not pressing, pushing extremely hard anyway. This is going to help that turn palm up because we want that palm up motion within the carpus, and that carpus is the group of carpal bones. So everything has to go palm up. So two techniques here and here stretches usually it's a duration of about 20 seconds for a stretch. Now we also have to turn it palm down, and you remember turning palm down, and that radius goes over the top of the ulna. So you're gonna turn it palm down as far as you can under your own muscle power to reach over the top and grab, and then use the heel of your opposite palm to push down on the radius, turning it palm down. And that would be right here on the end of your forearm. You can see that bone that pops up on you right there on the pinky side on the back of the wrist. You would go below that, grip, and then turn it palm down. We're gonna help it 20 seconds, then after 20 seconds, hold one, two, three, and relax. Then one more round of that. We usually have people do their stretches every two to three hours during their waking period, the time they're awake during the day. Now, let's move. One of the most important motions for function is wrist flexion, that's bending it toward the palm. So, a couple of ways to do it. Uh people have their own preferences. I show them multiple ways in the clinic of doing this. And one way is to bring it up, palm down, and just let it drop, and then use your muscles. The muscles that do that are here, and you're pull it, pull it down, and then help with the other hand right over the top, leaving the fingers free and stretching it down. Now, one nice technique is to raise the knee, lean the elbow into the thigh, make sure there's enough room for the wrist to bend and bring it down. Use your knee as a fulcrum, just bend that down with the fingers, with the fingers free. 20 seconds, end with a three-second hold. Okay. The opposite direction, still with the fingers out straight, flip it over, and now we're going to push your wrist into extension. You're bending the wrist toward the back of the hand. Again, 20 seconds, and with a three-second hold. Sometimes, if the hand doesn't turn palm up all the way, it's hard to do that. So you can just simply use the inside part of the knee, palm to palm, and then push that back. So you're using the inside part of the knee as a fulcrum. So I'm going to switch it to the other side and push it toward the back of the hand. Okay. Same is true for bending it toward the palm. You can use the outside part of the knee, keeping that forearm right and tight against your leg, your thigh, coming over the top, bend that, bend that wrist, bend that hinge, and get right in there. 20 seconds, three-second hold. Okay? And then the opposite direction that we just went over, wrist extension. Now, sometimes, well, always, I assess on my patients the tightness of the muscles that do this. So the way to assess that is to bring them both in line with each other and bend them down. So if this one, this one is bending down that far, but this one is only bending down that far, these cords that are wrapped around every one of these finger joints that are connected to these muscles up here are really, really tight. We need to get those that flexibility back. So what I have patients do is simply grab their fist and pull it down. Or going back to using the knee as a fulcrum, instead of keeping the fingers free, you grab the rip the whole fist and bend it down until you feel a light stretch over the back of the hand, and that's all those finger tendons stretching 20 seconds, and then relax. So there would be, in that case, there would be two fingers free and in a fist. Proper technique is crucial to get the proper range of motion so you can get your function back. That's why you really need to be seen in the clinic so it can be thoroughly assessed, all the details, and I usually just follow up with people once a week or once every 10 days or something. When they come in the clinic, I'm doing things for them that they can't do for themselves at home, like traction, which is separation of all these joints to loosen things up and give people a head start at home, and mobilization of the joints. For example, the distal radioulnar joint or drudge, where this the radius meets the ulna, and they move that like piano keys, loosen that up, and then traction more traction with gliding the bones back and forth, stretching the palmer arches, getting that, getting that stretch real good. Um, patients don't have three hands, they only have two, so I have to show them the techniques to for stretching themselves. But when they're in the clinic, I can use my two hands on their hand and really have more of a of a greater impact. So those are some of the techniques. I'll I'll be even sending my current patients to this episode so they can see these techniques from a different angle. Thank you very much for watching. Uh, thank you very much for subscribing and liking this episode, and thank you for sharing this with people who you think might benefit. Check out my website, CarlPetito.com. Thank you.