Hand Therapy

What makes hand therapy a specialty

The hand and wrist pack more joints, tendons and nerves into a small space than anywhere else in the body, and they tolerate error badly. A tendon repaired in the finger has to glide through a tight sheath; immobilize it too long and it scars down, move it too soon and it ruptures. The margin is narrow and it is measured in weeks.

That is why a distinct credential exists. A Certified Hand Therapist has spent at least three years in practice, accumulated 4,000 hours or more of direct upper-extremity treatment, and passed a four-hour, 200-question certification examination. Certification lasts five years and must then be renewed.

It is a meaningful signal when you are choosing where to go with a complex hand problem, and it is worth asking about wherever you end up.

What we treat

Hand therapy covers the whole upper extremity — fingers, hand, wrist, elbow and often the shoulder, because the chain does not stop at the wrist.

Nerve compression

ExamplesCarpal tunnel syndrome, cubital tunnel syndrome

What treatment tends to involveNight orthoses, nerve gliding, activity modification

Tendon problems

ExamplesTrigger finger, De Quervain's, tennis and golfer's elbow

What treatment tends to involveLoading programs, orthoses, hands-on treatment

After surgery

ExamplesFlexor and extensor tendon repair, fracture fixation, joint replacement

What treatment tends to involveProtocol-driven protected motion, scar and swelling management

Fractures and sprains

ExamplesDistal radius fracture, scaphoid, finger sprains

What treatment tends to involveRestoring motion after immobilization, then strength

Arthritis

ExamplesThumb base arthritis, rheumatoid changes

What treatment tends to involveJoint protection, custom orthoses, strengthening

Custom orthoses, made in the clinic

A large part of hand therapy is making things. Thermoplastic is heated, moulded directly to your hand, then adjusted as you heal — because the shape you need in week two is not the shape you need in week six.

Off-the-shelf braces have their place, and we use them where they fit the job. But a custom dorsal blocking orthosis remains the standard of care for protecting a repaired flexor tendon, and no prefabricated product substitutes for one. Fabricating on site also means an adjustment takes minutes at your next visit rather than a new order and a week of waiting.

After hand surgery, timing is the treatment

There is strong evidence that carefully designed rehabilitation programs are critical to outcomes after tendon injury, and that introducing controlled early motion improves healing, reduces complications and produces better final results than prolonged immobilization.

That only holds when the timing is right. Every surgeon works to a protocol specifying when motion starts, how much, and against what resistance. We follow the one your surgeon set. If you are having hand surgery, ask about therapy before the operation rather than after — the first appointment is often meant to happen within days of the repair, and a delay there is difficult to make up later.

What the evidence supports for carpal tunnel

Carpal tunnel syndrome is the most common reason people are referred for hand therapy, so it is worth being specific about what conservative treatment can do.

A systematic review of non-surgical management found the most reliable evidence for orthoses, nerve gliding exercises, carpal bone mobilization and therapeutic ultrasound. Splinting — particularly at night, when the wrist curls and compresses the nerve — has the most consistent support.

Conservative care is a reasonable first step for mild to moderate symptoms. It is less likely to be enough where there is constant numbness or visible muscle wasting at the base of the thumb, which suggests the nerve has been compressed long enough to need a surgical opinion. We will tell you which situation you are in rather than treating you indefinitely.