A guidewire manipulation device includes a housing sized to be supported by a hand of a user, the housing having a distal end and a proximal end a rotation member rotationally disposed within the housing a locking assembly coupled to the rotation member, the locking assembly configured to selectively transfer rotational movement of the rotation member to rotational movement of a guidewire a handle coupled to the housing and configured to be operable by the hand of the user and a drive system coupled to the handle, the drive system configured to apply alternating clockwise motion and counter-clockwise motion to the guidewire by causing the rotation member to rotate.