Hand Therapy - A Speciality Practice Area of Occupational Therapy

What is hand therapy? Conditions Often Treated With Hand Therapy

The ability to perform a variety of tasks, including grasping, manipulating objects, and using fine motor skills, depends on hand function. These skills are important for work and leisure activities in addition to daily tasks like getting dressed, eating, and writing. Additionally, communication and social interactions rely heavily on hand function. A person's independence and overall quality of life may be significantly impacted if their hands stop functioning effectively. Hand therapy with a physical therapist or occupational therapist is one possible course of treatment. Surgery may also be necessary in some circumstances.

What is hand therapy?

A type of rehabilitation known as hand therapy concentrates on the hand and upper extremities. Injuries, operations, and congenital conditions affecting the musculoskeletal and neurological systems of the upper extremity are all conditions that hand therapists are trained to assess and treat. They employ a variety of methods to increase mobility, strength, and dexterity, lessen pain and inflammation, and encourage healing.

Hand therapy aims to aid patients in regaining the use of their hands and enhancing their capacity to carry out activities of daily living, employment, and leisure. Hand therapists work with patients to help them regain independence and function as well as to stop further accidents.

Hand therapy may include techniques such as:

• Splinting and casting

• Soft tissue mobilization

• Joint mobilization

• Exercises to improve strength, range of motion, and coordination

• Education on the proper use of assistive devices, such as canes and crutches, and adaptive equipment

• Modalities such as ultrasound, electrical stimulation, and heat/cold therapy (note that some of these may be Controlled Acts or Restricted Activities for some therapists)

“Man, through the use of his hands, as they are energized by mind and will, can influence the state of his own health.” Mary Reilly, EdD.

Splinting

To immobilize, support, or safeguard the hand, wrist, or fingers, a hand splint is worn. They can treat a number of ailments, including tendinitis, carpal tunnel syndrome, fractures, sprains, and sprains. Additionally, they are utilized after surgery to immobilize the hand and wrist as the tissue heals.

Hand splints come in different types, such as:

• Static splints: are used to immobilize a specific joint or area of the hand and hold it in a fixed position to promote healing or to prevent further injury.

• Dynamic splints: are used to alter the range of passive motion in the affected joint. They are often used to treat arthritis, tendonitis, and nerve injuries.

• Resting hand splints: are used to maintain the hand in a functional position, prevent contractures, and reduce pain.

• Custom-made splints: are specially made to fit the individual's hand and are often used for complex conditions or after surgery.

Hand splints are typically made of lightweight materials that are comfortable to wear, like plastic or foam. They can be worn for a long time and are adjustable to fit different hand sizes. Following an assessment, a hand therapist will frequently recommend hand splints and will give the patient instructions on how to use and maintain the device. They'll keep an eye on the patient's development and make any necessary splint adjustments.

Soft Tissue Mobilization

A manual therapy known as soft tissue mobilization (STM) uses hands-on techniques to manipulate the body's soft tissues, including muscles, tendons, ligaments, and fascia. STM aims to increase the range of motion, lessen discomfort and inflammation, and enhance the function of the injured area.

STM techniques can include:

• Massage: to improve circulation, reduce muscle tension, and improve range of motion

• Myofascial release: to stretch and release the fascia, which is a connective tissue that surrounds muscles, tendons, and ligaments

• Friction massage: to break down scar tissue and adhesions

• Instrument-assisted soft tissue mobilization: the use of tools, such as the Graston Technique, to break down adhesions and scar tissue

• Passive stretching: to improve range of motion and flexibility

STM is commonly used to treat various conditions, such as musculoskeletal injuries, chronic pain, and overuse injuries. STM is frequently administered by therapists skilled in these methods, and it is to be a component of a thorough treatment strategy developed to meet the needs and objectives of the patient.

Joint mobilization

Joint mobilization is a manual therapy involving hands-on techniques to move a joint through its full range of motion. Joint mobilization aims to improve the range of motion, reduce pain and inflammation, and improve the affected joint's function.

Joint mobilization techniques can include:

• Gliding: involves a gentle movement of the joint in a specific direction to improve the range of motion

• Oscillation: involves a gentle rocking movement of the joint to improve the range of motion

• Distraction: involves a gentle stretching movement of the joint to improve the range of motion

• Manipulation: involves a quick, high-velocity movement of the joint to improve the range of motion.

There are 27 bones, 29 joints and at least 123 named ligaments in the human hand.

Conditions Often Treated With Hand Therapy

1. Carpal Tunnel Syndrome

2. Tendinitis

3. De Quervain's Tenosynovitis

4. Dupuytren's Contracture

Carpal Tunnel Syndrome

The median nerve, which travels from the forearm into the hand, can become compressed or squeezed at the wrist, resulting in carpal tunnel syndrome (CTS). The thumb, index, middle, and a portion of the ring finger are particularly vulnerable to pain, numbness, tingling, and weakness as a result of this compression. Genetics, repetitive motions, trauma, and underlying medical conditions like diabetes, rheumatoid arthritis, and pregnancy are some of the possible causes of CTS.

Symptoms of CTS can include:

• Numbness, tingling, or burning sensations in hand and fingers, especially the thumb, index, middle, and ring fingers.

• Weakness in the hand and fingers

• Pain or discomfort in the wrist or hand, especially at night

• Loss of grip strength

• Difficulty performing fine motor tasks such as buttoning clothes or picking up small objects.

Tendinitis

A tendon, which is the fibrous tissue that joins muscle to bone, becomes inflamed when it develops tendinitis. Even though tendonitis can happen anywhere on the body where a muscle meets a bone, it most frequently affects the shoulder, elbow, wrist, and knee. Tendinitis may result from overuse, repetitive motions, or an injury. It might also be a sign of a deeper issue like gout or rheumatoid arthritis.

Symptoms of tendinitis can include:

• Pain and tenderness near the affected joint

• Swelling and stiffness in the affected area

• Weakness in the affected muscle

• Difficulty moving the affected joint

• A creaking or crackling sound when moving the joint

De Quervain's Tenosynovitis

The condition De Quervain's tenosynovitis, also referred to as De Quervain's disease or "Mother's wrist," results in pain and inflammation in the tendons on the thumb side of the wrist. It is frequently the result of overuse or repetitive movements of the thumb and is brought on by inflammation of the tendons and the sheath that surrounds them. It is frequently observed in new mothers who engage in repetitive motions, like lifting and carrying their infants. However, it can also happen to people who perform manual labour, gardening, or musical instrument playing, which both require repetitive thumb and wrist movements.

Symptoms of De Quervain's tenosynovitis include:

• Pain and tenderness along the thumb side of the wrist

• Swelling and stiffness in the affected area

• Weakness in the affected muscle

• Difficulty grasping objects

• Painful "snapping" sensation when moving the thumb

Dupuytren's Contracture

The condition known as Dupuytren's contracture causes the tissue under the skin of the palm to thicken and contract, resulting in bent fingers. The ring and little fingers are typically affected, but the middle and index fingers can also be impacted. Although the precise cause of Dupuytren's contracture is unknown, a combination of genetic and environmental factors is thought to be responsible. Men and those with Northern European ancestry are more likely to experience it.

Symptoms of Dupuytren's contracture include:

• Thickening and tightening of the skin on the palm

• Development of tiny, hard lumps in the palm

• Gradual bending of the fingers towards the palm, making it difficult to straighten the affected fingers fully

• Pain or discomfort in the affected fingers

References:

Orthotic Intervention for the Hand and Upper Extremity: Splinting Principles and Process. (2013). United Kingdom: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Saunders, R., Astifidis, R. (2015). Hand and Upper Extremity Rehabilitation: A Practical Guide. United Kingdom: Elsevier.

What is Hand Therapy. (n.d.). The British Association of Hand Therapists. https://www.hand-therapy.co.uk/patients/what_is_hand_therapy.aspx