Q: Mobilization teq to improve MCP dcp joint mobilization A: Here is a thorough, clinically structured answer based on the X-rays and your question. --- Clinical Context from X-rays The X-rays show Deelip Patil, 66 yr/M with a left distal radius fracture likely Colles' type with K-wire fixation, with pre-op and post-op films from Feb-March 2026. The wrist hardware is proximal to the MCP and DIP joints, meaning finger joint mobilization is not only safe but essential early in rehab to prevent stiffness. --- Mobilization Techniques for MCP and DIP Joints Why These Joints Stiffen Post-Distal Radius Fracture After K-wire fixation and immobilization, the MCP and DIP joints stiffen due to: - Periarticular edema and fibrosis - Collateral ligament shortening MCPs are prone to stiffening in extension because collaterals are slack in this position - Flexor/extensor tendon adhesions - Prolonged casting --- 1. Passive Joint Mobilization Maitland Grades MCP Joint Grade Technique Purpose --------------------------- I-II Small/large amplitude oscillations at beginning of range, no resistance Pain relief, muscle guarding, early post-hardware phase III Large amplitude oscillations into resistance 50% of available range Begin reducing stiffness IV Small amplitude at end-range Stretch capsule, break adhesions Specific accessory mobilizations for MCP: - Volar glide AP glide: Therapist stabilizes the metacarpal head; applies volar palmar glide on the proximal phalanx base - improves MCP flexion - Dorsal glide: Improves MCP extension - Distraction/Traction: Long-axis traction of the proximal phalanx away from the metacarpal head - reduces pain, increases general ROM - Lateral/Medial glide: Improves abduction/adduction and overall capsular mobility Positioning: MCP mobilizations for flexion are most effective with the joint at approximately 60-70° flexion where the collateral ligaments are maximally taut and stretched. DIP Joint - Long-axis traction: Stabilize the middle phalanx; apply gentle distraction on the distal phalanx - reduces intra-articular pressure, improves ROM - Volar glide: Improves DIP flexion - Dorsal glide: Improves DIP extension common restriction after immobilization - Small amplitude Grade III-IV oscillations at end-range of extension when the mallet/boutonniere-type stiffness pattern is present --- 2. Tendon Gliding Exercises Active Mobilization These are the most important active techniques post distal radius K-wire surgery. Perform each position 10 repetitions, 3-5 times/day: Position Joints Primary Tendon Targeted ------------------------------------------ Straight position All extended Starting position Hook fist MCPs extended, PIPs+DIPs flexed Differential FDS/FDP glide Full fist All joints flexed Max FDP glide Straight fist MCPs+PIPs flexed, DIPs extended Max FDS glide Platform tabletop MCPs flexed, IPs extended Intrinsic muscles + extensor mechanism --- 3. Specific Techniques for Common Restrictions MCP Flexion Loss most common after immobilization - Blocking exercises: Stabilize MCPs at 90° flexion with the other hand; actively flex/extend IPs - isolates intrinsic motion - Place-and-hold flexion: Passively place fingers in composite flexion, hold 5-10 sec - Lumbrical bar splint: Maintains MCPs in flexion overnight, allows IP motion DIP Extension Loss / Flexion Contracture - Serial static extension splinting at DIP in maximum tolerated extension, worn between sessions - Dynamic DIP extension splinting if passive extension is present but active extension lags Intrinsic Tightness Test - If DIP/PIP flexion is more limited with MCP extended than with MCP flexed = intrinsic tightness - treat with MCPs in extension, stretching IP flexion passively --- 4. Edema Control prerequisite to all mobilization - Retrograde massage from fingertips toward wrist before mobilization - Compression gloves/coban wrapping finger-to-wrist direction - Elevation above heart level - Edema must be controlled first - mobilizing a swollen joint causes pain and reactivity --- 5. Progression Post K-wire, Hardware In Situ Phase Timing Focus ---------------------- Early 0-4 wk post-op Wires still in Tendon gliding, edema control, Grade I-II oscillations at MCPs/DIPs Middle 4-8 wk After wire removal Grade III-IV accessory mobilizations, blocking exercises, static progressive splinting Late 8-12 wk Consolidation phase Strengthening grip, pinch, functional tasks, composite fist drills --- Key Precautions for This Patient - Do not mobilize the wrist until surgical clearance after K-wire removal wires still appear present on the March 2026 films - MCP/DIP mobilization is safe and should begin early - the hardware is at the wrist level, not at the finger joints - Monitor for CRPS signs disproportionate pain, sweating, skin changes - common in elderly patients post distal radius fracture - If the thumb was also fixed appears so from the lateral film with a wire near the thumb CMC/MCP area, include thumb MCP mobilization separately with the same principles This regimen follows the standard approach described in Rockwood and Green's Fractures in Adults 10th Ed, 2025, which specifically states: "Digital stiffness should be addressed with hand therapy as soon as possible, including edema control, protected mobilization, and static-progressive splinting."
