Advice from a Certified Hand Therapist: Do hand therapists treat more than hands?

You might have pain in your shoulder or elbow, but your physician recommended that you see a Certified Hand Therapist (CHT).  You might be wondering why a hand and upper extremity specialist was recommended.
 
What is the Certified Hand Therapist (CHT) credential and what does it mean?
A CHT is an occupational therapist or physical therapist who has achieved at least 4,000 direct hand therapy contact hours with a minimum of three years of practice experience.  The certification examination includes advanced clinical skills and theoretical knowledge of the upper quarter: shoulder, elbow, wrist, hand, cervical spine, thoracic spine, and core utilization.  There are approximately 6,300 CHTs worldwide. 

What else does a Certified Hand Therapist (CHT) do?
CHTs are experts with respect to treatment of the entire arm, shoulder, and more.  Your therapist will take a history of your symptoms, discuss when you experience pain, and determine goals for treatment. An evaluation process might include:

• Range of motion testing: Taking measurements with a tool called a goniometer which measures how far you move in degrees
• Strength testing: This can be performed with you resisting pressure from a therapist's hand, using a device called a dynamometer that measures power grasp or a device that measures how hard you can pinch.
• Observation of functional task performance: This might be as easy as reaching behind your back as if you were putting on a belt, reaching overhead to put a glass in a cabinet, tying shoes, or pulling open a door.
• Sensory testing: To determine how well you can feel
• Coordination testing: Placing pegs into a board or manipulating objects
• Goals for treatment: Discuss how your current injury is impacting your hobbies and creating goals to return to those important activities

The above tasks will help your CHT to identify deficits and work with you towards your goals.

What are solutions to my identified problems?

• Exercises: If muscle imbalances or range of motion deficits are noted, exercises may be provided.
• Activity modification: Small changes in the way you perform a task may reduce your pain levels significantly.
• Ergonomic (science of work and proper positioning to avoid injury) suggestions: This may also be beneficial for your workspace.
• Manual therapy: Stretching exercises, management for scarring, or soft tissue mobilization/massage techniques may be necessary to improve muscle imbalances and pain.
• Modalities: Use of mild/comfortable electrical currents called e-stim, hot/cold packs, paraffin wax (melted wax to dip all or part of the hand in), ultrasound or fluidotherapy (a box full of chopped corn husk with a heater and a blower) can be used to decrease pain and improve function.

 In addition to the above interventions, a CHT will provide additional services that are unique to what you need.
 
How can a CHT help me?

• Education: Your CHT will provide you with education that you can utilize in your life and help with meaningful and functional things that you do in your everyday life. Your CHT will engage you in an essential teaching and learning process based on the individual needs for your success.
• Custom Orthosis Fabrication: Your CHT will assess and possibly fabricate a custom orthosis for you in order to rest, protect, assist and/or restore function.
• Adaptive equipment recommendations: Your CHT can make recommendations for equipment to make tasks easier to perform and less painful like an automatic jar opener or automatic chopper.

I feel really anxious about my pain or problem – can my CHT help with that too?
Yes! Hand and upper extremity therapists understand that when something hurts or doesn’t move as it should, that can cause a lot of anxiety or contribute to depression. Strategies to improve your ability to perform tasks and decrease pain can be helpful. Talk to your local CHT for a program that is catered to you!

Gwen Morris, OTD, OTR/L, CHT, CLT is a Certified Hand Therapist and a member of the American Society of Hand Therapists.