Bill Klaproth (Host): If you’re suffering with hand or arm issues, hand therapy may help. What is hand therapy? What is a hand therapist and how can that person help you? Well, here to talk with us today is Carrie DeLuca. She is a Certified Hand Therapist with Tidelands Health. Carrie, thanks so much for your time. What exactly is hand therapy?

Carrie DeLuca (Guest): Well, hand therapy is an area that specializes in treatment of the shoulder through the hand. It involves an evaluation and testing to come up with a specific treatment plan for the patient, whether it be post-op or conservative treatment.

Bill: And, who would be the best candidate for hand therapy? At what point does someone come to see you?

Carrie: Well, it just depends. If it’s a post-operative patient, we usually see them 3-5 days post-op. They could have injuries such as tendon injuries, ligament injuries, table saw injuries—any kind of traumatic injury that would require surgical repair. They would be sent to us or it could be conservative treatment. So, patients that have more chronic conditions like arthritis, rheumatoid arthritis, long-lasting or chronic tendonitis that has been around for a while—those types of patients.

Bill: So, people with traumatic injuries or chronic conditions. Those people are more likely to see a hand therapist.

Carrie: Right. And, if it involves anything from the shoulder down or the upper extremity or upper limb.

Bill: So, for someone that just has a shoulder ailment or hand issue for the first time, would they necessarily go to a hand therapist or would they see just a regular, traditional physical therapist?

Carrie: I would recommend them seeing a hand therapist and the referral would usually come from their primary care doctor or a general orthopedic. If it’s a post-op patient, it would come either from an orthopedic or a specialized hand surgeon.

Bill: So, does hand therapy work like traditional physical therapy or are you utilizing different strategies and techniques?

Carrie: Well, it’s similar but this area is specialized so a hand therapist can be an occupational therapist or a physical therapist. It’s just one area of specialization in that field.

Bill: Now, you were mentioning traumatic injuries and chronic injuries; what do you typically see the most of? What conditions benefit most from hand therapy, if you will?

Carrie: Okay. Well, if we’re talking about conservative treatment, some types of things that we may see that are more chronic conditions would be osteoarthritis, maybe of the thumb or a tendonitis of the hand or wrist which would be like De Quervain’s or a common thing that people probably hear of are things like tennis elbow or golfer’s elbow. Those are tendonitis’ in the elbow. Those are some common things that we would see.

Bill: How successful are you in treating those? What is the efficacy? Are you able to generally get that person back 100% or 90%? I know it’s individually based.

Carrie: Right.

Bill: And, subjective. But, in general, what do you think?

Carrie: Our goal is to get them back to the highest level of functioning. I wouldn’t say 100% but that would…You know, if we meet that, which we do sometimes, that would be great. That would be the ultimate goal but what we try to focus on most is function because we use our hands for everything. If you think about from the time you wake up, what you do with your hands even just until you get to work for the day, it would be difficult to do those things without your hands. So, our goal is to get the patient back to the highest level of functioning and, usually, if they have some type of injury in the upper extremity, they’re limited with those daily activities.

Bill: Right. And, you were mentioning earlier that you get patients that are referred by a doctor. Are there cases where someone would choose a hand therapist or actively look for a hand therapist instead of going to their primary care physician?

Carrie: Yes, there are. At Tidelands Health, we use a physician’s referral as our order. Most insurance require that we have physician referrals for coverage purposes. Sometimes, if they come without a referral and they just want to be evaluated by a hand therapist, we can do that. Their insurance may not necessarily cover it without the referral from the physician.

Bill: And, as far as hand therapists go, are you trained differently than a regular physical therapist? Do you specialize in, like you said, all the ailments from the shoulder down to the hand? Is that a hand specialist specialty?

Carrie: Yes, it is a specialty. You are required to be a physical therapist or occupational therapist. You’re required to have at least 5 years of experience as a therapist and then there is a specific exam to take to become a certified therapist. You have to have 5 years as a licensed therapist; you have to have 4,000 hours of practice in the upper extremity/hand therapy area and then you can sit for a certification exam. Once you sit for that exam and pass the exam, you can be a certified hand therapist.

Bill: Well, that would make sense. With all that training, that’s why you would see trauma patients and chronic conditions because you really are skilled and focused in on injuries and problems with the arms, etc. So, let me ask you this. Does the hand therapist then offer workplace training to train the individual on how to potentially not injure their arm; or, somebody that works with their hands ways that they can prevent these types of injuries?

Carrie: Yes. Part of our care would also be education and to help them prevent further injury or any other repetitive injuries. So, yes, definitely. Education is part of that.

Bill: So, for someone listening that may have a serious problem with their hand, arm, elbow or shoulder, what’s the most important thing you would say to them right now?

Carrie: It would just depend on the patient themselves and what was going on; what type of work they do; whether they’re a stay at home mom; whether they’re a construction worker; whether they do heavy labor; whether they do desk work. It would all depend on our evaluation and what the need of that particular individual was.

Bill: Okay. So, do most people know about hand therapists or is this something they would learn over the course of needing treatment?

Carrie: I think in healthcare, other therapists are aware of the specialty area. As far as the general public, unless you’ve ever had any type of injury to your hands, they probably don’t because they’ve never encountered a hand therapist. So, I think until you’re affected by some type hand injury or upper extremity injury, you don’t know that it’s available. Even if you are, sometimes you may just think that you just need to see an occupational therapist or a physical therapist. You don’t realize that there is a specialty area that can help you with that.

Bill: Right. Do you combine medications at all with the treatment plan? Do you work with the medications at all or are you just strictly the physical act of physical therapy on the arm or hand or whatever the affected area is?

Carrie: Well, we don’t prescribe medication but we do use some medications in our treatment depending on what we are treating. We use different modalities in our treatment, if they are necessary, whether it be ultrasound or E-stim. We have different types of moist heat, dry heat, paraffin. If we use E-stim, we use something called “iontophoresis” and this usually, most typically seen for tendonitis’. We use an electrical stimulation and we use medication and we deliver it through electrical stimulation. So, we do it to the area that we’re treating. So, it’s a localized treatment. The medication doesn’t need to be ingested, so it’s not systemic. It just goes straight to the area that’s being treated. We don’t prescribe the medication, a physician does. But, we do use it in our treatment.

Bill: Carrie, why should someone choose Tideland’s health for their hand therapy needs?

Carrie: Well, I obviously think that we’re the best. We have certified hand therapists on our staff. We have a hand therapy center that just specializes in hand therapy treatment. We have several therapists with many years of experience, so I think that this is the place to come to get back to functioning and using your hands independently.

Bill: Well, Carrie, thank you so much for your time today. It’s been very interesting learning about hand therapy and what a hand therapist does. For more information about Tidelands Health physicians and facilities such as hand therapy, visit www.tidelandshealth.org. that’s www.tidelandshealth.org. This is Better Health Radio. I’m Bill Klaproth. Thanks for listening.