Carolina Occupational Therapy Hand & Upper Extremity Rehabilitation

Why sending your patient to Hand Therapy can be a key/crucial piece in your treatment plan....


Exclusive Benefits for our MDs/PAs/FNPs/CNM

Close your eyes and picture hand therapy. What comes to mind? Do you see an older patient squeezing a wad of therapy putty while cracking a joke about how OT stands for Outrageous Torture? Do you picture hand weights, therapy band, and hotpacks?  Although you would likely see many of these things in a hand clinic, hand therapy is so much more.  In reality, the hand and upper extremity is a complex biomechanical system that drives every aspect of a person’s daily life.

The hand is a very complex organ with multiple joints, different types of ligament, tendons and nerves. It consists of 27 bones (including the 8 bones of the wrist). When the other associated structures (nerves, arteries, veins, muscles, tendons, ligaments, joint cartilage, etc.) are considered, the potential for a variety of injuries exists when trauma involves the hand.  Hand disease/injuries are common in society and can result from excessive use, degenerative disorders or trauma.  Intricate in design and function, the hand is an amazing work of anatomic engineering.  People use their hands from the moment they wake up until the very last moments before they fall asleep.  It is nearly possible to perform any meaningful activity without the use of hands.  Disease processes and injuries to the underlying structures of the hand carries the potential for serious handicap.  Loss of the use of the hand(s)  = significant loss of function.  This can apply to even the smallest of hand injuries.  The goal with injuries to the hand is a rapid and accurate initial evaluation and treatment. In other words, once an injury occurs, the physician/practitioner should strive to begin medical treatment quickly so the short- and long-term effects on the hand can be minimized.  A very important part of that process is Hand Therapy.   FACT - Optimal outcomes are more likely to be realized/achieved when there is active collaboration between a surgeon/physician/PA-C/FNP and hand therapists given the complexity of the structures themselves, the time-sensitive nature of many diagnoses (for example, tendon repair & rehabilitation), and medical/therapy adherence & compliance.  Hand therapy is inherently different from other therapies because it requires following fundamentally different instructions, can be time consuming, and often painful.  Some people are non-adherent in that they do too much, while others do too little and since the therapist and treating surgeon often have to make adjustments in the instructions during the course of treatment, the therapeutic demands will constantly change. On the other hand, the adherence does not need to be followed "forever" but rather, always has a limited time frame making it easier to comply with (acute as opposed to chronic).

                                                         IT'S ALL ABOUT THE COMPLIANCE....

WE INSURE COMPLIANCE AND COMMUNICATE WHEN THAT IS A FACTOR.  Hand surgery relies on post-operative and sometimes pre-operative hand therapy for good results.  Though in some types of surgery it is more critical than others, adherence to therapy is recognized as an important predictor of results.  The ability to recognize barriers to patient adherence prior to surgery may be helpful to the hand surgeon in preoperative, operative and postoperative planning.  The success of hand surgery relies heavily on post-operative therapy. The ability to identify barriers to patient adherence with therapy may therefore allow for improvement in therapeutic and surgical decisions and results. 

​                                                                  A COMMON MISCONCEPTION....

HAND THERAPY IS NOT EXCLUSIVELY FOR PEOPLE WHO HAVE UNDERGONE TENDON TRANSFER SURGERIES, CMC/MP ARTHROPLASTIES, ETC....  It is for ALL THINGS HAND/WRIST/FOREARM/SHOULDER.  Hand therapists tend to consider function first and can be a great resource for other patients who need less aggressive programs emphasizing functional usage.  The next time you’re struggling with an upper extremity patient or feel that your patient could benefit from custom immobilization to provide rest and balance to affected tissue, hand therapy could be just what YOU ordered.... 


In this day and age of higher co-pays and deductibles, it would seem prudent to reduce your patient's out of pocket expenses.  Time and time again, patients are choosing to decline necessary services because they cannot afford to pay for them.  The keyword being necessary, not optional.  Many practitioners keep their patient's expenses in mind when making decisions in their plan of care.  Unfortunately, in the context of doing their best to help their patients SAVE money, that decision could, in the long run, cost their patients much more money than if they had referred the patient to therapy.  If a patient is at high risk to develop post-operative stiffness, to develop an infection, for muscular atrophy/wasting, for Complex Regional Pain Syndrome (CRPS), and etc., a referral to skilled hand therapy with  an OTR/L, CHT could potentially eliminate or reduce those risks.  Quite often, one or two visits to hand therapy can give their patient the instruction/tools necessary to reduce those risks.  Clinical studies prove that delayed onset of therapy significantly increased the chance of morbidity and, as such, required longer duration of therapy and/or more therapy visits to resolve than if the patient had been referred for an initial evaluation to determine appropriateness and necessity to start hand therapy.  In the end, more therapy/longer therapy = increased cost to the patient. In some instances, delayed referral to Hand Therapy can result in patient needing more diagnostic tests and even addition surgical procedures which again  = more expense for the patient.  Early initiation of Hand Therapy can simply be a referral for a one-time visit for and evaluation/treatment.  During the initial evaluation, a skilled, competent, and ethical CHT would be able to determine if the patient demonstrated high potential to experience experience notable/significant benefit participating in skilled therapy services.  During that same initial visit, the CHT may conclude after the initial evaluation that participation in skilled OT Hand Therapy services  would not have a major impact, would not have achieve significant benefit, would not be tolerant, and/or a high-risk for non-compliance and therefore not a good candidate.

For those practitioners - MD, PA-C, CNM, FNP, etc. that do not typically see/treat many upper extremity issues if any and would like an "expert opinion"/help/guidance, a one-time referral to a CHT for evaluation could provide valuable insight and/or a clearer direction.  Often, given the amount of one-on-one evaluation time that the CHT has at their disposal, they sometimes "pick-up" on things that may have not been evident in the time spent in the exam room with the practitioner.  The CHT may determine that the patient would significantly benefit from skilled Hand Therapy services, sometimes not.  Many times, subtle things that were not easily observed by the practitioner reveal themselves while being seen by the CHT resulting in more clearly defined diagnosis by the practitioner after the CHT communicates their findings to them.  Example: patient lacerates their wrist with a knife. They were seen in the ED by an MD who assessed the injury and treated all obvious injuries.  However, the patient follows up 10 days later with decreased hand function. The etiology was not able to be established.  The practitioner referred the patient to the CHT for evaluation/treatment.  During the course of the evaluation, the sensory test revealed possible lacerated sensory branch of a nerve.  The CHT then communicates their findings to the MD who then directs the patient to their next logical course of care.


  • Immediate referral acceptance/work-in of any patient with acute needs (splinting, wound care, etc.) upon your request (patients being treated under worker's compensation would need authorization that day)
  • Immediate Access to all therapists to discuss patient progress, patient needs, post-operative instructions, anything you need to convey directly to the therapists in a timely manner.
  • Detailed typed re-evaluations will be sent with all patients to their follow-up appointments with you that will include attendance, treatment plan, progress, barriers, etc.  (unless the patient does not attend the re-evaluation session prior to their appointment with you).
  • Timely communications to you and/or your office if your patient has been non-compliant.  This includes both attendance and/or with therapy program itself, splinting etc.
  • We will communicate with you in the manner you are most comfortable with (email, phone, text, etc)
  • WE PROMISE THAT FINANCES WILL NOT BE A BARRIER TO RECEIVING ANY NEEDED SKILLED THERAPY SERVICES.  Health insurance, cost of healthcare, etc. continue to constantly change.  Higher co-pays and deductibles cause great distress to many patients.  In many cases, Hand Therapy is NOT OPTIONAL.  They  may have had a tendon/nerve repair, amputation, peripheral nerve compression, etc.  Hand function MUST be restored in order to return to work and engage in meaning life activities.  They may have significant pain.  As detailed in the "FINANCES" section of this website, we can make this work for anybody regardless of financial abilities.  Our status as a non-affiliated outpatient OT hand therapy clinic gives us flexibility that 95% of other facilities do not have.  We DO NOT turn anybody away regardless of their ability to pay.  Please contact Mike if you have specific questions regarding this topic.    ​