Hand Therapy

Support for hand, wrist and upper-limb recovery

Problems affecting the hand or wrist can make everyday tasks such as writing, typing, gripping, dressing, cooking or working difficult. Symptoms may develop after an injury or surgery, or gradually through conditions affecting the joints, tendons or nerves.

Hand therapy focuses on restoring movement, strength and practical use of the hand while protecting healing structures where necessary. Treatment may include exercises, splinting, swelling management, scar care and advice on returning to normal activities.

When hand therapy may help

Hand therapy may be suitable for:

• Hand, finger or wrist injuries
• Wrist or hand fractures
• Tendon injuries
• Rehabilitation after tendon repair
• Ligament and finger sprains
• Reduced movement after immobilisation
• Hand or wrist stiffness
• Arthritis affecting the hand or wrist
• Carpal tunnel syndrome
• Thumb and wrist pain
• De Quervain’s syndrome
• Trigger finger or thumb
• Nerve injuries
• Sensitive or painful scars
• Swelling following injury or surgery
• Weak grip or reduced hand function
• Rehabilitation following hand or wrist surgery
• Difficulty returning to work or everyday activities

Hand therapy can support both recent injuries and longer-term conditions that affect how comfortably and effectively the hand and wrist can be used.

Understanding hand and wrist problems

The hand contains many small joints, tendons, muscles, ligaments and nerves that work together during even simple movements.

An injury to one area can affect movement elsewhere. Pain or swelling may make gripping difficult, while a period in a cast or splint can lead to stiffness and weakness.

For this reason, hand therapy looks at how the hand works as a whole and how the problem affects the activities you need to perform.

Treatment will depend on whether the main issue is pain, stiffness, weakness, swelling, altered sensation or the need to protect a healing structure.

What happens during your first appointment?

Your first appointment begins with a discussion about your symptoms, injury or operation and the activities you are finding difficult.

The therapist may ask:

• When the problem started
• Whether there was an injury
• Whether you have had surgery
• Where you experience pain or stiffness
• Whether swelling is present
• Whether you experience numbness or altered sensation
• Which movements are difficult
• What work you do
• Which hobbies or sports you take part in
• What treatment you have already received
• What activities you would like to return to

The assessment may include:

• Finger, thumb and wrist movement
• Grip and hand strength
• Swelling
• Joint stiffness
• Tendon movement
• Scar mobility and sensitivity
• Sensation where relevant
• Coordination and practical hand use
• Movements related to work or daily activities

The findings are then used to develop a treatment plan based on your current function and recovery goals.

What treatment may include

Treatment will depend on the condition, stage of healing and activities you need to return to.

Movement exercises

Exercises may be used to restore or maintain movement in the fingers, thumb and wrist.

These can be particularly important following injury, surgery or a period of immobilisation when stiffness has developed.

Strengthening

Once appropriate, exercises may be introduced to rebuild grip, pinch and wrist strength.

The programme can gradually progress towards activities such as carrying, lifting, gripping tools or returning to sport.

Splinting

A splint may be used to protect an injured structure, support a joint, reduce aggravating movement or position the hand appropriately during healing.

The type of splint will depend on the condition and the level of protection or support required.

Swelling management

Swelling is common after hand injuries and surgery and can contribute to stiffness and reduced movement.

Treatment may include movement, positioning, elevation, compression or other swelling-management techniques where appropriate.

Scar management

Following surgery or injury, a scar may feel tight, raised or sensitive and can sometimes affect movement.

Once the wound has healed sufficiently, treatment may include scar massage, movement and desensitisation techniques where appropriate.

Sensory rehabilitation

Nerve injuries or sensitive scars can sometimes change the way touch feels.

Hand therapy may include exercises designed to gradually improve tolerance to touch and help manage altered or uncomfortable sensation.

Home exercise programme

You may receive exercises to complete between appointments. These will depend on your condition and, particularly after surgery, may need to follow specific movement restrictions.

Hand and wrist fractures

A fracture can lead to pain, swelling, stiffness and difficulty using the hand or wrist.

Some fractures are treated with a cast or splint, while others may require surgery. Once movement is considered safe, rehabilitation can help restore function.

Treatment may focus on:

• Reducing stiffness
• Restoring finger and wrist movement
• Managing swelling
• Rebuilding grip strength
• Improving practical hand use
• Returning gradually to lifting and carrying

The rehabilitation plan depends on where the fracture occurred, its severity and how it has been treated.

Tendon injuries and repairs

Tendons allow the fingers and thumb to bend and straighten. When a tendon is significantly injured, surgery may sometimes be required.

Rehabilitation following tendon repair needs to protect the healing tendon while also introducing controlled movement at the appropriate stage.

Treatment may include:

• A protective splint
• Carefully controlled exercises
• Swelling management
• Scar management
• Gradual progression of movement
• Strengthening at a later stage
• Gradual return to normal hand use

Following the recommended programme is particularly important after tendon surgery because the repair needs time to heal before heavier activity is introduced.

Finger and ligament injuries

Finger sprains, dislocations and ligament injuries can leave a joint swollen, painful or stiff even after the initial injury has settled.

Depending on the injury, treatment may include:

• Protective splinting or strapping
• Finger movement exercises
• Stretching
• Swelling management
• Gradual strengthening
• Returning to gripping and everyday activity

Rehabilitation aims to restore useful movement while allowing the injured tissues enough time to recover.

Carpal tunnel syndrome

Carpal tunnel syndrome occurs when the median nerve is compressed as it passes through the wrist.

Symptoms may include numbness, tingling, discomfort or weakness in the hand. They can sometimes be more noticeable at night or during repeated hand activities.

Management may include:

• Advice about activities that aggravate symptoms
• Wrist positioning
• A night splint where appropriate
• Hand or nerve exercises
• Guidance on work or repetitive tasks

Persistent or worsening symptoms may require further medical assessment.

Thumb and wrist pain

Pain around the thumb or wrist can make gripping, lifting, opening containers and using a phone or computer uncomfortable.

Treatment may include:

• Movement exercises
• Gradual strengthening
• Advice on gripping and lifting
• Splinting where appropriate
• Changes to repetitive activities
• A gradual return to normal hand use

The treatment approach depends on where the symptoms are located and which activities are affected.

Arthritis of the hand and wrist

Arthritis can lead to pain, stiffness and reduced grip, making activities such as opening jars, turning keys, writing or handling smaller objects more difficult.

Hand therapy may focus on maintaining useful movement, improving strength and finding practical ways to reduce unnecessary strain during everyday tasks.

Treatment may include:

• Hand and wrist exercises
• Strengthening
• Splints or supports
• Activity modification
• Joint protection advice
• Practical strategies for daily activities

The aim is to maintain function and make everyday hand use more manageable.

Managing swelling and stiffness

The hand can become stiff relatively quickly following injury, surgery or immobilisation.

Swelling may make it harder to bend or straighten the fingers and can also affect grip.

Treatment may include:

• Elevation where appropriate
• Gentle movement
• Compression when suitable
• Finger and wrist exercises
• Gradually increasing normal hand use

The approach will depend on the injury and whether any structures still need to be protected.

Scar sensitivity

A scar may remain tender or unusually sensitive after the wound itself has healed.

Everyday contact with clothing, objects or different textures may feel uncomfortable.

Desensitisation techniques may involve gradually exposing the area to different types of touch or pressure. Scar massage may also be used where appropriate once healing allows.

Treatment is progressed gradually according to comfort and the condition of the scar.

Returning to everyday activities

The hand is involved in a large number of daily tasks, so rehabilitation should consider what you actually need to use it for.

This may include:

• Dressing
• Cooking
• Writing
• Typing
• Driving
• Using a phone
• Carrying shopping
• Opening containers
• Household tasks
• Caring for a child
• Hobbies and crafts

Treatment can gradually progress towards these activities as movement, strength and confidence improve.

Returning to work

Hand and wrist problems can have a significant effect on work, particularly where a job involves gripping, lifting, typing, using tools or repeated hand movements.

Rehabilitation may consider the specific physical requirements of your job.

Depending on the condition, treatment may include:

• Grip strengthening
• Wrist strengthening
• Repeated movement practice
• Advice on temporarily modifying tasks
• Splinting
• Gradual return to heavier activity

The aim is to rebuild the level of hand function needed for your normal work rather than simply improving strength in isolation.

Returning to sport and exercise

Sports and exercise can place very different demands on the hand and wrist.

Gym training may require strong gripping and weight-bearing through the wrist, while racket sports, climbing or ball sports may involve repeated impact, catching or rapid hand movements.

Later-stage rehabilitation may therefore include:

• Grip strengthening
• Weight-bearing exercises
• Wrist control
• Catching or throwing
• Progressive lifting
• Sport-specific movements

The return to activity should reflect the original injury, healing stage and physical demands of the sport.

Rehabilitation after hand or wrist surgery

Hand therapy often forms an important part of recovery following surgery.

The rehabilitation plan depends on the procedure. Some operations allow movement relatively early, while others require a structure to remain protected for a specific period.

Treatment may include:

• Protective splinting
• Controlled movement
• Swelling management
• Scar care
• Restoring joint movement
• Gradual strengthening
• Improving hand function
• Returning to work or normal activity

Post-operative exercises should follow the guidance given for the specific procedure rather than a general hand exercise programme.

When further medical assessment may be needed

Not every hand or wrist problem should be treated as a routine rehabilitation issue.

Further assessment may be needed following:

• A significant injury with obvious deformity
• A suspected fracture or dislocation
• A deep cut with loss of finger movement
• Sudden loss of hand or finger function
• Significant or worsening numbness
• Signs of wound infection
• Rapidly increasing swelling
• Severe pain following trauma

If concerns are identified during your assessment, further investigation or review by another healthcare professional may be recommended.

Treatment based on what you need your hand to do

The aim of rehabilitation differs from person to person.

You may want to:

• Make a full fist again
• Grip objects more comfortably
• Return to typing
• Use tools at work
• Lift weights
• Play an instrument
• Return to sport
• Reduce stiffness after surgery
• Improve hand strength
• Manage a long-term condition
• Regain confidence using an injured hand

Your rehabilitation can be developed around these practical goals rather than focusing only on measurements of movement or strength.

How long will rehabilitation take?

Recovery depends on the condition, severity of the injury and whether surgery has been required.

A relatively minor injury may require a short period of exercises and advice. Fractures, tendon repairs, nerve injuries or more complex surgery may need rehabilitation over a longer period.

Some conditions also have specific healing restrictions that determine when strengthening or heavier activity can begin.

Your progress can be reviewed throughout treatment and the programme adjusted as movement, strength and hand function improve.