The use of joint mobilization to improve clinical outcomes in hand therapy

Joint mobilizations are employed as an intervention for improving range of motion, reducing pain and ultimately improving function in patients with a wide variety of upper extremity diagnoses. However, there are only a limited number of studies describing this treatment for conditions affecting the elbow, wrist, and hand. Furthermore, it is not clear as to the most effective joint mobilization technique utilized and the most beneficial functional outcomes gained. The authors conducted this review to investigate the current evidence describing joint mobilizations for treatment of conditions of the elbow, wrist and hand, and offer informative practical clinical guidance. Twenty-two studies dated between 1980 and 2011 were included in the systematic review for analysis. They found that the current evidence offers moderate support for the inclusion of joint mobilizations in the treatment of lateral epicondylalgia (LE). In particular, mobilization with movement as described by Mulligan is supported with evidence from nine randomized clinical trials as an effective technique for the treatment of pain. Other described techniques include those known as Kaltenborn, Cyriax physical therapy, and Maitland, but the evidence for these techniques is limited. There is also limited evidence for the joint mobilizations in the treatment of wrist and hand conditions.

 

The authors concluded that the current literature provides limited support for joint mobilizations of the wrist and hand, and moderate support for joint mobilizations of the elbow for LE. They also found that there is moderate support for mobilization with movement.

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