Author Archives: the American Society of Hand Therapists

Hand Hand Therapy Pencil Grip

Advice from a Certified Hand Therapist: Modifications to Pencil Grip for Handwriting

As a pediatric hand therapist, I see clients who hold their pens and pencils a little bit differently than most. Typically, these clients are using a different grip to compensate for weakness or loose joints. An altered grasp is not in itself a bad thing until it creates a problem.

The problem is usually a complaint of pain with handwriting. An individual with loose joints develops an altered grasp pattern in order to increase stability when writing, thus allowing them to write clearly. An example of a modified grip is excessive extension of the tip of the fingers or thumb along with excessive flexion of the second joint of the thumb.

Another example involves holding the pencil tight in the first web space while using all four fingers and thumb to stabilize the pencil.

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Arthritis Hand Hand Therapy Thumb Thumb Arthritis

Ask a Therapist: Thumb Arthritis

Certified Hand Therapist Michelle McMurray, MOT, OTR/L, CHT discusses thumb arthritis, also known as basal joint arthritis.


Basal joint arthritis, or thumb arthritis, is the most common site of arthritis in the hand.  This may also be referred to as the CMC (carpometacarpal) joint.  Pain typically occurs at the base of the thumb where the hand meets the wrist.  People typically report pain and weakness with grasping or pinching activities. Most people do not realize how important this particular joint is to the function of the hand until it hurts.  The amount of force transmitted through the CMC joint holding a 1-pound object at the tip is amplified to over 13 pounds at the CMC joint.  Basic activities of daily living can require between 6 and 8 pounds of pinch at the tip of the thumb, which would be amplified more than 10 times that at the base of the thumb!  Over time, this can cause break-down of the joint with loss of cartilage (the smooth part of the joint) and inflammation.  This is sometimes a painful process.

When this occurs in the body, what options do we have to feel better?  Most people do not choose surgery as their first option, and it is often not recommended as the first option.  Initial options may include injections, splinting, medications and/or rest.  Additionally, there are modifications that can be made to our daily activities which may also help to decrease the pain.

Here are a few examples of some easy and inexpensive ways to protect your hands to decrease the stress and inflammation at your thumb:

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Hand Hand Surgery Hand Therapy

What is a Hand Therapist?

I have been told to see a hand therapist, but am unsure what that means. Who provides “hand therapy”?

A hand therapist is an occupational therapist (OT) or physical therapist (PT) who has specific training and expertise in treating hand and arm conditions. Typically, this person has spent many additional years gaining expertise with hand and arm injuries and treatment. When an OT or PT has reached this higher level of experience, they often become a Certified Hand Therapist (CHT).

So I can see anyone that is a PT, OT or CHT to take care of my problem?

You will want to ensure that the therapist you see, whether it is an OT or a PT, is qualified to treat your condition. If they are a CHT, it means they have had extra training and passed a rigorous exam to demonstrate their skill. If they are an OT or a PT, they may still treat hand and arm conditions, but you should ask questions to ensure they have spent extra time after their formal education learning about the hand and arm. To find a hand therapist near you, click here.

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Baseball Elbow Hand Sports Injury

Advice from a Certified Hand Therapist: Treating Tommy John Injuries

Baseball season is in full swing for the pros. Unfortunately, for many youth baseball players, summer leagues are just one of the year-round seasons they play. A Tommy John injury (injury of the ulnar collateral ligament at the elbow) was unheard of in youth leagues in the mid-90s. By 2010, the adolescent rate was nearly 40 percent. As a baseball enthusiast, I find this trend disturbing. I asked Dr. Bobby Chhabra, Chair of the Orthopedic Department at the University of Virginia, his perception of this epidemic.

“Every year I see more and more adolescent elbow injuries from pitching and throwing. These injuries vary across a spectrum from little leaguer’s elbow, to muscle strains, to UCL injuries (Tommy John), and cartilage injuries. I would agree that the adolescent rate is increasing and the trend shows that this group may soon reach half of all surgeries performed to repair a Tommy John injury. 

The reasons for this are likely multi-factorial but include the increasing number of kids who play one sport and pitch year round from a young age, have poor mechanics, have fatigue leading to poor mechanics and injury, and have overuse with minimal rest.  

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Hand Musician Pain

Advice from a Certified Hand Therapist for Musicians

©furtseff/fotolia

“…the instrument becomes an extension of the body, for example, the bow of the violinist or the drumsticks of the drummer.” – Schlinger, 2006.

Many musicians say they “merge” with their instrument when they are playing – that they lose themselves and do not know where they stop and the instrument begins. This process leads to beautiful music; however, it can lead to less body awareness, pain and overuse injuries related to playing their instrument.

Statistics estimate more than 39,000 people are formally employed as musicians in the United States. This does not include the large numbers of children and teenagers just starting out, or devoted amateur and professional musicians playing night and weekend shows. Among this large number of musicians, studies have shown that the percentage who report having play-related pain may actually be higher than in other professions. In some groups, more than 90% of musicians surveyed reported having some type of pain.

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Hand Hand Therapy Mirror Therapy Pain

Advice from a Certified Hand Therapist: Mirror Therapy for Chronic Pain

Chronic pain that does not respond to conventional treatment can be frustrating for both the person with the pain and the team of people trying to help alleviate the pain. You may have heard of mirror therapy, but are unsure of what it is or who can benefit. To answer these questions, I consulted Susan Stralka, PT, DPT, MS. Susan has many years of experience treating patients with chronic pain and has lectured around the world on this topic.

What is mirror therapy?

Mirror therapy is a rehabilitation technique that uses the mirror image of a non-painful limb to retrain the brain about its perception of a painful limb. The non-painful limb (such as a hand or foot) is placed in front of a mirror and the painful limb is placed behind the mirror out of sight.

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Hand Therapy Joint Pain Joints

Advice from a Certified Hand Therapist: Techniques to Reduce Joint Pain

For this post, we are sharing a video that demonstrates many techniques you can use on a daily basis to protect your joints. In past posts, we’ve discussed joint protection and gave some examples and illustrations of this. (See Protecting Your Joints and Living With(out) Thumb Pain.)

The video below shows some of those examples in action. The video has no sound, so don’t worry about turning up the volume. As you watch, you will be given some practical pointers. There are some questions in the video, so put on your thinking cap and see what ideas you come up with to take care of your joints.

After watching the video, you may have questions about specific activities and how to make changes to decrease your joint pain. Talking to a certified hand therapist can help you apply these principles to your specific activities, which can help you to keep doing what you want in life.

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Arm Hand Numbness Thoracic Outlet Syndrome

Advice from a Certified Hand Therapist: Can a T-Shirt Improve Posture and Help Treat Arm Pain?

Are you someone who suffers from thoracic outlet syndrome and has arm pain? Perhaps this special t-shirt is for you!

Arm pain and tingling is a common symptom of thoracic outlet syndrome (TOS). TOS is a term used to describe compression in the space between the collarbone and the first rib. Other symptoms include numbness in the arm and hand, pain and aches in the neck, shoulder or hand and arm fatigue with activity. While the cause of TOS is compression, the cause of the compression can be due to a number of factors. One common offender is poor posture. The posture that is often associated with TOS is drooping or rounded shoulders and holding the head in a forward position.

TOS is often treated with rehabilitation, medication and sometimes surgery. During rehabilitation treatment, an emphasis is placed on improving posture through exercises, stretches and use of athletic taping techniques. Taping provides support and gentle feedback to guide the shoulder into a better position. A more recent development is a t-shirt that mimics the taping technology and accomplishes a similar effect with greater ease.

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