The wrist is an extremely delicate structure that requires mobility and yet stability. Sometimes this balance goes wrong, and then osteopathic intervention is appropriate. Techniques can be general or specific, and although general techniques can often be effective in restoration of function, specific manipulative skill is sometimes essential. Some apparently pathological conditions can be influenced by osteopathic treatment such as carpal tunnel syndrome, and osteopathic management including direct work on the wrist and hand can be valuable.
Special precautions need be considered in relation to the true cause of symptoms. In many cases there is hypermobility, and although this will manifest as subjective stiffness, accurate motion testing should reveal the real nature of the problem. Undiagnosed fracture of the scaphoid, for example, is well documented in books on fractures and traumatology and should never be overlooked. Inflammatory disorders such as rheumatoid arthritis need special care, and although gentle short treatment can be helpful, excessive mobilization is not wise.
28.1 • General mobilization The patient is lying supine and the operator is performing alternating ulnar and radial deviation with his hands, gripping around the wrist. This will produce a shearing force that will reach many of the carpal articulations.
Tips: Try fixing with one hand and moving the other or using both hands. This hold can be applied to the palmar or dorsal surface of the wrist.
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