Hand Therapy

Rehabilitation is a multidisciplinary, patient-centred, evidence-based process to promote healing, restore function, and promote independence. The physical and psychological and social consequences of the hand condition or injury have to be considered. Mobilization can be active or passive, supplemented by accessory movements and proprioceptive rehabilitation. Splinting may be static, serial static, static progressive, dynamic. Many materials are available. Oedema may be acute or chronic; it is treated with elevation, active movement, retrograde massage, compression, kinesiotaping, cold therapy, and contrast bathing. Scars may be mature or immature; keloid or hypertrophic. Management is generally empiric: massage, silicone, pressure therapy, steroid injections, and surgery all have roles. Hypersensitivity (allodynia, causalgia, dysaesthesia, hyperpathia, etc.) is treated with desensitization, graded textures, percussion, and mirror visual feedback. Stiffness is managed especially by prevention; movement, splinting, and surgery have a role. Pain is treated with medication, oedema control, acupuncture, TENS, education, psychological measures. Complex Regional Pain Syndrome has sensory, vasomotor, sudomotor, and trophic elements. Treatment includes medication, hand therapy, and occasionally surgery.