What is hand therapy? What a hand therapist does and who pays

Maybe your surgeon said "I'll send you to hand therapy", or you saw the words on a referral letter. You probably have questions: what is it, who are these therapists, and will your insurance pay?

This article explains what hand therapy is, what a first appointment usually looks like, how referrals work in the US and the UK, and how payment works in the US. It does not tell you what your own care should look like. Your therapist decides that with you, after seeing your hand.

What is hand therapy?

The American Society of Hand Therapists (ASHT) describes hand therapy as the art and science of assessing and caring for injuries and conditions of the upper extremity: the shoulder, arm, elbow, forearm, wrist and hand. Its aim, in ASHT's words, is to help a person return to their highest level of function.

People see a hand therapist for many reasons. ASHT mentions everything from simple fingertip injuries to complex surgery to reattach a finger or hand, as well as long-term conditions such as arthritis and neurological conditions such as a stroke. You might also be sent after a broken wrist (see hand stiffness after a cast) or after carpal tunnel surgery (see hand exercises after surgery).

What does a hand therapist do?

According to ASHT, a hand therapist is an occupational therapist or a physical therapist who has built up extra knowledge of the arm and hand through continuing education and clinical experience. In the UK, Arthritis UK describes hand therapists in a similar way: HCPC-registered occupational therapists or physiotherapists with further training in conditions of the upper limb. HCPC is the Health and Care Professions Council, the UK regulator for these professions.

The sources describe these parts of the job:

• Help without surgery, help after surgery, and preventive care.
• Activity and exercise programs, often to do at home between visits.
• Custom-made orthoses, which many people know as splints.
• Help with pain, swelling, wounds and scars.
• Advice on protecting your joints and saving energy if you have a long-term condition such as arthritis.
• Advice on aids and adaptations for daily activities and work.

Arthritis UK notes that hand therapists often plan the care after hand or arm surgery together with orthopedic surgeons.

What is a certified hand therapist (CHT)?

In the US, a hand therapist can take an extra step and become a certified hand therapist (CHT). ASHT explains that to earn the CHT credential, a therapist needs at least three years of practice, at least 4,000 hours of hands-on work with hand and arm conditions, and a pass on a certification exam.

If the credential matters to you, it is fine to ask.

Hand therapist, occupational therapist or physical therapist?

It is often not either/or. A hand therapist is an occupational therapist (OT) or a physical therapist (PT), with extra training and experience in the arm and hand. At the Royal United Hospitals in Bath, for example, the hand therapy team is made up of physiotherapists who specialize in the hand, wrist and elbow.

So if your doctor refers you to "hand therapy", you may meet an OT or a PT. Both can be hand therapists.

What happens at your first appointment?

Every clinic is different, but a leaflet from the Royal United Hospitals Bath gives a useful picture. There, a first appointment often takes about 40 minutes, and follow-up appointments tend to last about 30 minutes.

At the first visit, the therapist asks questions to understand your needs and concerns. From your answers, they explain the problems they have found, so you understand your condition. They then put together a program you can do at home.

The same leaflet gives two practical tips:

• Bring your splint if you already have one, especially if it is causing problems, so the therapist can check that it still fits.
• Wear clothes that let the therapist see your whole arm.

If you have a wound dressing, the leaflet says you should still come to your appointment. How many appointments you need differs from person to person. Your therapist can tell you what to expect in your case. Between appointments, you usually have a home program to follow.

Do you need a referral, and who pays?

United States

The American Physical Therapy Association (APTA) says that all 50 states, the District of Columbia and the US Virgin Islands allow some form of direct access to physical therapists. Direct access means you can book without a doctor's referral first. APTA adds that the rules and limits differ between states. APTA's overview is about physical therapists. If your hand therapist is an occupational therapist, ask the clinic or your insurer whether you need a referral first. ASHT's patient leaflet also notes that a prescription from your physician may be necessary before you can see a hand therapist.

Medicare Part B helps pay for medically necessary outpatient occupational therapy and physical therapy. Medicare.gov says that after the Part B deductible, you pay 20% of the Medicare-approved amount. Your doctor or another health care provider, such as a nurse practitioner or physician assistant, must certify that you need this care. There is no yearly limit on what Medicare pays for medically necessary outpatient therapy.

With private insurance, rules vary from plan to plan. Before your first visit, check your plan or call your insurer. Ask whether you need a referral, whether the therapist is in your network, and how many visits are covered.

United Kingdom

In the UK, you usually reach NHS hand therapy through a referral. At Queen Victoria Hospital in Sussex, for example, GPs, consultants and registered occupational therapists and physiotherapists can refer, and adults registered at a few local practices can refer themselves. Rules differ between hospitals, so ask your GP or consultant how it works in your area.

You can also check that your therapist is HCPC-registered.

Questions to ask your hand therapist

A first appointment brings a lot of information at once. Writing down a few questions beforehand helps. You could ask:

1. What did you find, and can you explain it in plain words?
2. Which exercises should I do at home, how often, and can you show me once more?
3. How much discomfort is okay during an exercise, and when should I stop?
4. If I have a splint: when do I wear it, and what should I look out for?
5. How many appointments do you expect, and when will my program change?
6. How do I reach you if something feels wrong before my next visit?

Asking "will this work?" is natural. A question your therapist can often answer more concretely is "what can I expect by my next appointment?"