Hand Therapy: How Occupational Therapists Treat Hand and Wrist Injuries

The hand is one of the most complex structures in the human body — a precision instrument capable of enormous delicacy and considerable force. When an injury or condition affects the hand, wrist, or forearm, the impact on daily life can be immediate and significant. Hand therapy — a specialized area of practice within both occupational therapy and physical therapy — addresses the rehabilitation of these injuries with the goal of restoring function and enabling return to daily activities and work.

What Is a Certified Hand Therapist?

A Certified Hand Therapist (CHT) is an occupational therapist or physical therapist who has completed a minimum of three years of clinical experience, at least 4,000 hours of direct practice in hand therapy, and passed a comprehensive examination in hand therapy. The CHT credential is awarded by the Hand Therapy Certification Commission and represents a high level of specialized expertise.

Many occupational therapists work with hand injuries without holding the CHT credential, but for complex injuries, a CHT is often the preferred provider.

Conditions Treated by Hand Therapists

Hand therapists treat a wide range of injuries and conditions affecting the upper extremity — from the fingertips to the shoulder:

Fractures: Fractures of the fingers, hand bones, wrist, and forearm require careful rehabilitation to restore motion, strength, and function while protecting the healing bone.

Tendon injuries: Injuries to the tendons that flex and extend the fingers require highly specialized rehabilitation protocols. The timing and progression of exercises is critical to preventing rupture of the repair while avoiding scar tissue adhesion.

Nerve injuries: Injuries to the median, ulnar, or radial nerves can cause weakness, numbness, and loss of hand function. Rehabilitation focuses on protecting the nerve, managing sensory changes, and promoting functional recovery.

Carpal tunnel syndrome: Compression of the median nerve at the wrist causes numbness, tingling, and weakness in the hand. Conservative treatment includes splinting, activity modification, and exercises; post-surgical rehabilitation addresses recovery after carpal tunnel release.

Trigger finger: A condition in which a finger catches or locks when bent. Treatment may include splinting, tendon gliding exercises, and activity modification.

De Quervain's tenosynovitis: Inflammation of the tendons on the thumb side of the wrist, causing pain with gripping and pinching. Treatment includes splinting, activity modification, and exercises.

Dupuytren's contracture: A condition in which fibrous tissue in the palm causes the fingers to curl toward the palm. Post-procedural rehabilitation focuses on restoring extension and functional use.

Rheumatoid arthritis and osteoarthritis: Arthritis of the hand and wrist affects joint integrity, strength, and function. Hand therapists work on joint protection techniques, adaptive equipment, exercise, and pain management.

Burns: Burns to the hand require specialized rehabilitation to prevent contracture formation and restore functional hand use.

Repetitive strain injuries: Conditions arising from repetitive work activities, such as tendinitis and overuse syndromes, are addressed through activity modification, splinting, and targeted exercises.

Amputations: Following finger or partial hand amputation, hand therapists address wound healing, desensitization, prosthetic training if appropriate, and adaptation of daily tasks.

What Happens in Hand Therapy

Hand therapy typically begins shortly after an injury or surgery, sometimes as early as the first day after a procedure. The early focus is on managing swelling and pain, protecting healing structures, and beginning gentle movement to prevent stiffness and adhesion.

Splinting and orthoses: Custom-fabricated splints are a hallmark of hand therapy. Hand therapists design and fabricate splints from thermoplastic materials to immobilize specific joints, position the hand and wrist for optimal healing, or provide dynamic assistance to regain range of motion.

Edema management: Swelling after injury or surgery impairs motion and function. Techniques include elevation, compression wrapping, massage, and specific exercises to reduce edema.

Range of motion exercises: Restoring the motion needed for daily hand function is a primary focus of rehabilitation. Exercises are progressed carefully based on the healing timeline for the specific tissue involved.

Strengthening: As healing progresses, strengthening exercises rebuild the grip and pinch strength needed for daily activities and work.

Scar management: Post-surgical and post-injury scars can limit motion if not managed appropriately. Techniques include massage, compression, and silicone gel application.

Sensory re-education: Following nerve injuries, sensory re-education helps the nervous system learn to interpret altered sensory signals.

Functional training: The ultimate goal is return to daily activities and work. Hand therapists work directly on the tasks that matter most to the individual.

When to Seek Hand Therapy

Following a hand or wrist injury or surgery, your surgeon will typically provide a referral to hand therapy. The timing of referral depends on the specific injury and the surgical approach used.

If you have a chronic hand condition — arthritis, carpal tunnel syndrome, trigger finger — that is affecting your daily function, a referral to a hand therapist for evaluation and conservative management is appropriate before considering surgical intervention.

Prompt initiation of hand therapy after injury or surgery consistently produces better outcomes than delayed referral.