What is Hand Therapy?

Hand Therapy is the term commonly used for rehabilitation of the hand and upper limb – most commonly for conditions involving the elbow, forearm, wrist, hand, fingers or thumb. These conditions may be caused by an injury (most ACC claims), a disease (eg arthritis) or a disorder such as carpal tunnel syndrome. The “therapy”, consists of assessment and treatment of the condition by a registered Physiotherapist or Occupational Therapist with specialized skills in this area.

What is a Hand Therapist?

A hand therapist can be either a physiotherapist or an Occupational Therapist who has either undergone undergraduate training or gained clinical experience in treating patients with upper limb conditions in order to become specialized in this area of practice.

In New Zealand, all registered hand therapists who have specific training in hand therapy will be members of the New Zealand Association of Hand Therapists (link to NZAHT). This is a professional body which monitors the training and ongoing professional education of its members.

The NZAHT defines Hand Therapists as registered Physiotherapists and Occupational Therapists who, through continuing education, clinical experience and independent study have become proficient in the treatment of upper extremity conditions resulting from trauma, disease and congenital deformity.

What Conditions Does a Hand Therapist Treat?

There are an enormous number of conditions of the hand and upper limb that hand therapists treat. The level of skill of the therapist will depend on the number of years he/she has been working in this area of practice and the scope of that practice – eg. experience working in a hospital department as well as outpatient clinics and private practice gives a broad base of experience. Continuing education and post graduate or masters level study in this specialty area is a good indication that the therapist also has an in depth knowledge academically as well as clinically. Below is a list of some of the conditions that can be treated by a hand therapist – in alphabetical order …

Arthiritis

Osteoarthritis and Rheumatoid arthritis. Treatment may include pain relief, protective/supportive splinting, joint protection advice and exercises.

Burns

Depending on how severe the burn, treatment may include splinting, pressure garment measuring and fitting, range of movement exercises and scar management.

Carpel Tunnel Syndrome

Splinting of the wrist, nerve gliding exercises, advice and education. If the patient has had carpal tunnel release surgery, they may need tendon and nerve gliding exercises post operatively as well as scar management and work hardening.

De Quervains Tenosynovitis (Tenosynovitis)

This is a condition affecting the tendons that extend the thumb and wrist. When these become inflamed it can be very painful and debilitating. Hand therapists can help by splinting the wrist and thumb to rest the area for a period of time. Rest combined with treatment +/- a corticosteroid injection usually settles this condition in time.

Ligament

Injuries to the joints of the thumb (eg. skiers’ thumb), fingers or wrist usually occur as a result of some sort of trauma (injury). Ligaments help to stabilize joints, so a period of splinting to immobilize or protect the joint is necessary. Range of motion exercises ensure that the joint does not become stiff during the time the joint is splinted.

Muscle

Tear, sprain or haematoma (bruising) – protect, soft tissue massage, stretch, strengthen.

Overuse Injuries

Also referred to as OOS (occupational overuse syndrome) or repetitive strain injury.

Pain Management

Pain may be caused by a number of different factors. Understanding the underlying pathology and having an in depth knowledge of pain mechanisms at a central nervous system level will make a big difference as to how effective a hand therapist can be in helping to reduce pain. Modalities such as TENS, Acupuncture and heat are just a few examples of techniques that can be called on depending on the level of skill of the therapist

Scar Management

There are a number of good products available to hand therapists which are effective in improving scar appearance and texture. Treatment of may also include soft tissue massage, pressure, stretch and even acupuncture if the therapist has training in this area.

Tendons

May be sprained or strained, torn or lacerated (cut). Lacerated tendons require surgical repair, splinting and a controlled exercise regime implemented by an experienced hand therapist who is familiar with the surgical technique and tendon rehab protocol used by the referring surgeon.

Wound Management

Many post-operative patients require dressings, stitch removal, and wound debridement. A hand therapist should have the necessary wound care products available in their clinic to optimize wound healing, which is often necessary before other therapy treatments and techniques can begin.