Bottom left Thrust metacarpophalangeal

joints This operator viewpoint photograph shows the operator is fixing and pulling back the meta-carpal while applying a traction and flexion force to the phalange.

Tips: Least useful in inflammatory disorders such as rheumatoid arthritis.

28.17 • (bottom right) Thrust interphalangeal joints This operator viewpoint photograph shows the patient's pronated hand gripped at the wrist. The operator's finger and thumb of the other hand are applying a medial and lateral gapping force to the interphalangeal joint.

Tips: Keep the interphalangeal joint slightly flexed to reduce strain on the capsule and to take the lateral ligaments off tension. This technique may require several priming movements until the tension accumulates efficiently.

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