Classification
- Type: Synovial condyloid (biaxial)
- Degrees of freedom: 2 (flexion/extension, radial/ulnar deviation)
- Region: Wrist complex (along with the midcarpal, intercarpal, and distal radioulnar joints)
Articular Surfaces
- Distal radius (concave): The distal articular surface of the radius is concave in both the sagittal and frontal planes, creating a biconcave surface. It faces distally and slightly palmarly (approximately 10° palmar tilt) and ulnarly (approximately 25° ulnar inclination). These angles are important landmarks for fracture reduction.
- Proximal carpal row (convex): The scaphoid, lunate, and triquetrum form a smooth convex surface that articulates with the distal radius. The scaphoid and lunate articulate directly with the radius; the triquetrum articulates with the TFCC (not directly with the ulna).
- TFCC (articular disc): Separates the ulnar head from the proximal carpal row and acts as the articular surface for the triquetrum (and part of the lunate) against the ulna. See anatomy/joints/distal-radioulnar for TFCC details.
Movements and ROM
Combined motion: Wrist flexion/extension is shared between the radiocarpal and midcarpal joints in approximately equal proportions. Radial deviation occurs primarily at the midcarpal joint; ulnar deviation occurs primarily at the radiocarpal joint. The total functional arc of motion occurs across both joints.
Capsular Pattern
Equal limitation of flexion and extension
When the radiocarpal capsule is restricted, flexion and extension losses are approximately equal. This distinguishes capsular pathology (OA, post-immobilization capsulitis) from non-capsular patterns (e.g., scaphoid fracture limiting radial deviation specifically, or TFCC tear limiting ulnar deviation).
Resting Position
- Neutral with slight ulnar deviation
- Maximum capsular volume
Close-Packed Position
- Full extension with radial deviation
- Maximum bony congruence, capsule and ligaments maximally taut
End-Feels
| Movement |
Normal End-Feel |
Type |
| Flexion |
Capsular (firm) |
Dorsal radiocarpal ligaments and dorsal capsule |
| Extension |
Capsular (firm) |
Palmar radiocarpal ligaments and palmar capsule |
| Radial deviation |
Bony (hard) |
Scaphoid contacts the radial styloid |
| Ulnar deviation |
Capsular (firm) |
Radial collateral ligament and lateral capsule |
Ligaments
Palmar Radiocarpal Ligaments
- Attachments: Palmar surface of the distal radius → scaphoid, lunate, triquetrum, and capitate (multiple bands: radioscaphocapitate, radiolunate, radioscapholunate)
- Function: The palmar ligaments are stronger than the dorsal ligaments — they are the primary restraints against wrist extension and dorsal carpal displacement. This is why carpal dislocations typically displace dorsally (the weaker dorsal ligaments fail first).
- Injury mechanism: Hyperextension injury (fall on outstretched hand) stresses the palmar ligaments. If force exceeds ligament strength, perilunate dislocation occurs.
- Condition link: Perilunate/lunate dislocation, carpal instability
Dorsal Radiocarpal Ligaments
- Attachments: Dorsal distal radius → triquetrum (dorsal radiotriquetral ligament is the primary component)
- Function: Resists wrist flexion and palmar carpal displacement. Weaker than palmar ligaments.
- Injury mechanism: Hyperflexion injury — less common than hyperextension
Radial Collateral Ligament
- Attachments: Radial styloid process → scaphoid and trapezium
- Function: Resists ulnar deviation
- Injury mechanism: Forced ulnar deviation; rarely injured in isolation
Ulnar Collateral Ligament
- Attachments: Ulnar styloid process → triquetrum and pisiform
- Function: Resists radial deviation
- Injury mechanism: Forced radial deviation; often involved in TFCC injuries
Mobilization Techniques
Hands-on instruction is required. The descriptions below provide clinical reference detail for understanding and supervised practice. They are not a substitute for instructor-led technique training. Correct hand placement, force dosage, and tissue response interpretation require hands-on coaching and feedback.
Convex-Concave Rule at the Radiocarpal Joint
The proximal carpal row is
convex and the distal radius is
concave. When mobilizing the convex carpals on the fixed concave radius, the glide is in the
opposite direction to the restricted movement.
| Restricted Movement |
Glide Direction |
Reasoning |
| Flexion |
Dorsal (posterior) glide |
Flexion moves the carpals palmarly → convex on concave → glide opposite → dorsal |
| Extension |
Palmar (anterior) glide |
Extension moves the carpals dorsally → convex on concave → glide opposite → palmar |
| Radial deviation |
Ulnar glide |
Convex on concave → glide opposite to the restriction |
| Ulnar deviation |
Radial glide |
Convex on concave → glide opposite to the restriction |
General Contraindications
- Absolute: Carpal fracture (especially scaphoid — the most commonly fractured carpal bone), carpal dislocation or instability, active infection, malignancy, RA with active synovitis
- Relative: Distal radius fracture (Colles', Smith's — wait for healing and surgeon clearance), osteoporosis (Grade I–II only), carpal tunnel syndrome (avoid sustained palmar pressure that increases carpal tunnel pressure)
Dorsal (Posterior) Carpal Glide
Purpose: Restores wrist flexion. Stretches the dorsal capsule and dorsal radiocarpal ligaments. The most commonly needed radiocarpal mobilization after Colles' fracture (which typically restricts flexion more than extension due to dorsal capsular scarring).
Patient position:
- Seated with the forearm pronated, resting on the table
- The wrist extends beyond the table edge so the hand hangs freely
- Alternatively: forearm supported on a wedge with the wrist at the distal edge
Hand placement:
- Stabilizing hand: Grips the distal radius and ulna from the dorsal side, pressing the forearm into the table. The web space contacts the dorsal forearm just proximal to the radiocarpal joint line.
- Mobilizing hand: Grips the proximal carpal row from the palmar side. The thenar eminence contacts the palmar surface of the proximal carpal row (scaphoid and lunate). Fingers wrap dorsally.
Technique execution:
- Apply a slow, sustained or oscillatory force directed dorsally (posteriorly) — pushing the proximal carpal row dorsally on the fixed radius
- Grade I–II: Small oscillations within the pain-free range for pain modulation. Appropriate in early post-fracture rehabilitation.
- Grade III–IV: Oscillations at end-range into the dorsal capsular resistance. You should feel the firm dorsal capsular barrier.
- Rhythm: 1–2 oscillations per second
- Duration: 30–60 seconds per set, 3–5 sets
- Reassess wrist flexion PROM between sets
Indications:
- Decreased wrist flexion with capsular (firm) end-feel
- Post-Colles' fracture stiffness (the most common indication)
- Post-immobilization wrist stiffness following the capsular pattern
- Joint play assessment reveals decreased dorsal glide
Technique notes:
- Common error: Gripping too distally (over the metacarpals rather than the proximal carpal row) — this mobilizes the midcarpal joint, not the radiocarpal.
- Common error: Allowing the forearm to lift off the table — the radius must be firmly stabilized.
- Reassessment: Re-test wrist flexion PROM. Improvement of 5–10° per session is reasonable in post-fracture stiffness.
- Integration: Perform after release of wrist extensors (ECRL, ECRB, ECU) and forearm fascia.
Palmar (Anterior) Carpal Glide
Purpose: Restores wrist extension. Stretches the palmar capsule and palmar radiocarpal ligaments. Important for activities requiring wrist extension (push-ups, weight bearing through hands).
Patient position:
- Seated with the forearm supinated, resting on the table
- Wrist extends beyond the table edge
Hand placement:
- Stabilizing hand: Grips the distal radius and ulna from the palmar side, pressing the forearm into the table
- Mobilizing hand: Grips the proximal carpal row from the dorsal side. The thenar eminence contacts the dorsal proximal carpal row. Force directed palmarly (anteriorly).
Technique execution:
- Apply a slow, sustained or oscillatory force directed palmarly — pushing the carpal row anteriorly on the fixed radius
- Grade I–II: Pain modulation
- Grade III–IV: Oscillations into the palmar capsular resistance
- Duration: 30–60 seconds per set, 3–5 sets
Indications:
- Decreased wrist extension with capsular (firm) end-feel
- Post-immobilization stiffness
- Joint play assessment reveals decreased palmar glide
Technique notes:
- Carpal tunnel caution: Sustained palmar pressure on the carpals increases carpal tunnel pressure. If the patient has carpal tunnel symptoms, use oscillatory (not sustained) techniques and monitor for symptom reproduction.
- Reassessment: Re-test wrist extension PROM.
Muscles Crossing This Joint
Wrist Flexors (Anterior)
Wrist Extensors (Posterior)
Extrinsic Finger Muscles (cross the wrist)
Conditions Affecting This Joint
- Distal radius fracture (Colles' fracture — the most common wrist fracture; dorsal displacement; Smith's fracture — palmar displacement) — post-fracture wrist stiffness is the primary indication for radiocarpal mobilization
- conditions/carpal-tunnel-syndrome — the carpal tunnel is bounded by carpal bones and the flexor retinaculum; radiocarpal pathology and CTS frequently coexist
- conditions/osteoarthritis — radiocarpal OA follows the capsular pattern; common after intra-articular fracture (post-traumatic OA)
- Scaphoid fracture — the most commonly fractured carpal bone; blood supply enters distally, making the proximal pole vulnerable to avascular necrosis; "anatomical snuffbox" tenderness is the classic finding
- Carpal instability — scapholunate ligament tear produces DISI (dorsal intercalated segment instability); common after fall on outstretched hand
Clinical Notes
- Post-Colles' fracture stiffness is the most common indication for radiocarpal mobilization. Colles' fractures are the most common wrist fracture (distal radius, dorsal displacement, "dinner fork" deformity). After cast removal, wrist flexion is typically the most limited movement due to dorsal capsular scarring. Dorsal carpal glide is the first mobilization technique applied.
- Scaphoid fractures are frequently missed. Anatomical snuffbox tenderness after a fall on an outstretched hand should be treated as a scaphoid fracture until imaging proves otherwise. Initial radiographs are negative in 15–20% of scaphoid fractures — repeat imaging at 10–14 days if clinical suspicion remains. Do not mobilize the wrist if scaphoid fracture is suspected.
- The radiocarpal and midcarpal joints share wrist motion. When mobilizing for wrist stiffness, assess and treat both joints. A restriction that does not respond to radiocarpal mobilization may be primarily midcarpal. Stabilize the proximal carpal row and mobilize the distal carpal row to assess midcarpal joint play.
Key Takeaways
- Convex proximal carpal row on concave radius means glide is opposite to the restricted movement — dorsal glide restores flexion, palmar glide restores extension.
- Post-Colles' fracture stiffness is the most common indication for radiocarpal mobilization — flexion is typically most limited.
- Always rule out scaphoid fracture (anatomical snuffbox tenderness) before mobilizing the wrist after trauma — initial radiographs are negative in up to 20% of cases.
- Wrist motion is shared between radiocarpal and midcarpal joints — assess and treat both when wrist ROM is limited.
