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Hand Therapy - A Speciality Practice Area of Occupational Therapy


What is hand therapy? Conditions Often Treated With Hand Therapy


Hand function is crucial because it allows for the ability to perform various tasks such as grasping, manipulating objects, and performing fine motor skills. These abilities are necessary for daily living activities such as dressing, eating, and writing and are also important for work and leisure activities. In addition, hand function plays a critical role in social interactions and communication. If a person's hands stop working efficiently, this may significantly impact their overall quality of life and independence. Treatment options may include hand therapy with a physical therapist or occupational therapist, and in some cases, may ever require surgery.


What is hand therapy?


Hand therapy is a form of rehabilitation focusing on the hand and upper extremities. Hand therapists are trained to evaluate and treat conditions related to the musculoskeletal and neurological systems of the upper extremity, including injuries, surgeries, and congenital conditions. They use various techniques to improve range of motion, strength, and dexterity, reduce pain and inflammation, and promote healing.


The goal of hand therapy is to help individuals regain the use of their hands and improve their ability to perform activities of daily living, work, and leisure activities. Hand therapists work with patients to help them regain function and independence and to prevent future injuries.


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


A hand splint is used to immobilize, support, or protect the hand, wrist, or fingers. They can treat various conditions, such as fractures, sprains, strains, tendinitis, and carpal tunnel syndrome. They are also used post-surgery to immobilize the hand and wrist while the tissue is healing.


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, such as plastic or foam, and are designed to be comfortable to wear. They are adjustable to fit different hand sizes and can be worn for extended periods.

A hand therapist often prescribes hand splints after an evaluation, and the therapist will instruct the patient on how to use and care for the splint properly. They will monitor the patient's progress and adjust the splint as needed.



Soft Tissue Mobilization


Soft tissue mobilization (STM) is a manual therapy involving hands-on techniques to manipulate the body's soft tissues, such as muscles, tendons, ligaments, and fascia. The goal of STM is to improve the range of motion, reduce pain and inflammation, and improve the function of the affected 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 typically done by therapists trained in these techniques and should be part of a comprehensive treatment plan tailored to the individual's needs and goals.

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


Carpal Tunnel Syndrome (CTS) is a condition that occurs when the median nerve, which runs from the forearm into the hand, becomes compressed or squeezed at the wrist. This compression can cause pain, numbness, tingling, and weakness in the hand and fingers, particularly in the thumb, index, middle, and part of the ring finger. CTS is caused by a combination of factors that can include genetics, repetitive motions, trauma, and underlying medical conditions such as diabetes, rheumatoid arthritis, and pregnancy.



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


Tendinitis is the inflammation of a tendon, which is the fibrous tissue that connects muscle to bone. Tendinitis can occur in any part of the body where a tendon connects muscle to bone, but it is most common in the shoulder, elbow, wrist, and knee. Repetitive motions, overuse, or injury can cause tendinitis. It can also be a symptom of an underlying condition such as rheumatoid arthritis or gout.

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


De Quervain's tenosynovitis, also known as De Quervain's disease or "Mother's wrist," is a condition that causes pain and inflammation in the tendons on the thumb side of the wrist. It is caused by the inflammation of the tendons and the sheath that surrounds them and is often the result of overuse or repetitive movements of the thumb. It is commonly seen in new mothers who perform repetitive motions such as lifting and carrying their newborns. Still, it can also occur in people who engage in repetitive thumb and wrist movements, such as manual labour, gardening, or playing musical instruments.

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


Dupuytren's contracture is a condition in which the tissue under the skin of the palm thickens and contracts, leading to bent fingers. It typically affects the ring finger and little finger but can also affect the middle and index fingers. The exact cause of Dupuytren's contracture is unknown, but it is thought to be a combination of genetic and environmental factors. It is more common in men and people of Northern European descent.


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

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