What is Hand Therapy?

What is Hand Therapy?

“Don’t look at the world with your hands in your pockets. To write about it, you have to reach out and touch it.” Mark Twain’s simple quote is rich with sensation and imagination of what hands are capable of. Stop for a moment and think about getting through your daily routine without the use of your hands. It’s a devastating thought.

The number of hand injuries occurring yearly in the United States is startling. In 2014, the National Electronic Injury Surveillance System (NEISS) database has recorded an estimated 4,008,147 upper extremity injuries presenting to the US emergency departments.

The upper extremity injuries are financially straining and potentially life altering. Individuals who sustain hand injuries should seek the most appropriate therapy providers to ensure efficiency of care, cost, and maximal recovery. When the arm injury is medically stable, a therapist specializing in hand therapy is recommended. Certified Hand Therapists (CHT) – experts in upper extremity rehabilitation – have dedicated at least 5 years and 4,000 hours of their medical education and training to the rehabilitation of upper extremity injuries and surgeries.

What Diagnoses are Referred to Hand Therapists?

Hand therapists treat numerous diagnoses and conditions that affect the upper extremity. The table below includes some of the surgical and non-surgical conditions that may be referred to a hand therapist:

Conditions Treated by Certified Hand Therapists
Thumb

  • trigger thumb
  • amputations
  • arthritis
  • de Quervain’s tenosynovitis
  • fractures
Hand/Fingers

  • finger sprains/ strains
  • trigger fingers
  • amputations
  • arthritis
  • fractures
Wrist

  • wrist fractures
  • carpal tunnel syndrome
  • TFCC injuries
  • strains/ sprains
Elbow

  • tennis elbow
  • golfers elbow
  • cubital tunnel
  • dislocations
  • fractures
Shoulder

  • rotator cuff injuries
  • frozen shoulder
  • fractures
  • thoracic outlet syndrome
General/Misc.

  • ligament injuries
  • tendon injuries
  • repetitive strain injuries
  • burns
  • tumors/cysts

Injuries of the upper extremity clinically present with varied symptoms including swelling, pain, decreased motion, loss of strength, altered sensation, and impaired functional use. More complex diagnoses affecting the upper extremity that require specialized intervention include: tendon injuries, ligament injuries, dislocations, crush injuries, amputations, burns, Dupuytren’s disease, brachial plexus nerve injuries, and thoracic outlet syndrome.

What Specialized Skills Does a Hand Therapist Have?

Hand therapists perform a specialized evaluation to determine the most appropriate treatment to enhance upper extremity recovery.

Techniques

The rehabilitation process involves a variety of skilled techniques. Hand therapists are proficient in hands-on techniques including:

  • Soft tissue manipulation for swelling, scar tissue, and muscle tightness
  • Manual stretching and mobilization of tight joints and muscles
  • Scar and wound management, including desensitization and sensory re-education

Modalities

Hand therapists have advanced training in the use of various modalities to help reduce pain and swelling, including:

  • Ultrasound
  • Heat
  • Ice
  • Paraffin
  • Elastic tape
  • Iontophoresis
  • Other modalities that can assist with muscle re-education, e.g. electrical stimulation

They are also trained in ergonomic education, work hardening, activity modification, energy conservation, and joint protection principles.

Custom Splinting/Orthoses

Lastly, hand therapists are highly experienced in assessing the needs for custom splinting/orthoses. They have mastered fabrication, fitting, and progression of various specialized prefabricated splints and braces, as well as custom fabrication of static and dynamic splints/orthoses.

The custom orthoses are used to advance recovery in the acute phase, as well as provide protection when individuals resume life, work, sports and hobbies. For maximal recovery, orthosis fabrication and education is often a paramount adjunct to the hands-on therapy.

How Do I Find a Hand Therapist?

The Hand Therapy Certification Commission (HTCC) currently represents 6,291 Certified Hand Therapists worldwide, of which 5,707 are in the United States. CHT is broken down by profession:

  • 85% occupational therapists
  • 14% physical therapists
  •  1% is represented by both professions

To locate a CHT, search the HTCC database.

Most CHTs belong to The American Society of Hand Therapy (ASHT). ASHT is a professional organization of over 3,300 licensed occupational and physical therapists that specialize in the treatment and rehabilitation of the upper extremity. ASHT also has a searchable database for locating a hand therapist.