Introduction

Occupational therapy, a profession related to healthcare, helps people tackle challenges related to daily activities, adopt a better lifestyle, and prevent the loss of function. It significantly contributes to the rehabilitation of an injured person and helps them recover from injuries like hand injuries. Almost all daily activities are performed with the help of hands, from easy tasks like eating and dressing to complex ones such as working on a laptop or doing desk jobs. Injuries to the hand can impact the quality of life, so proper rehabilitation is crucial. This article sheds light on the role of occupational therapy in hand injuries, from assessment to treatment approaches and into the multidisciplinary approach.

Understanding hand injuries

Injuries to the hands are quite common in all ages and among different genders. They are not geographically restricted either. Although they are rarely dangerous, they do require treatment and can result in disabilities that affect their ability to work and engage in daily activities. They are primarily caused at work, during sporting events, and sometimes in household settings, traffic accidents, or at public places.

Types of hand injuries

Fractures

Broken bones in the hand can be due to falls, impacts, or crushing injuries. Common fractures include those of the fingers, wrist, and elbow.¹

Tendon injuries

Tendons are the tissues that connect muscles to bones and facilitate movement. Injuries may result in the form of cuts or trauma that makes people generally less able to bend their fingers.¹

Nerve injuries

They cause numbness, tingling, or weakness. Examples include carpal tunnel syndrome and ulnar nerve injuries.

Lacerations and soft tissue injuries

This type of wound causes damage to the skin, muscle, or connective tissues; this damage leads to pain and dysfunction.¹

Dislocations

When it involves hand dislocation, bones in the hand or wrist are forced out of their normal position; it has characteristic features of severe pain, deformation, and immobilisation.

Sprain

A condition in which one or more ligaments holding your joint in place are stretched or even torn. Ligaments connect bones to your joints. When they have been stretched or torn, your joints may become unstable, and you'll also experience pain and inflammation.

Sprains occur whenever you twist, turn or stretch some joints beyond their normal range of motion. They may have come about as a result of running or jumping or playing sports and being subjected to landing awkwardly or turning abruptly.

Causes of hand injuries

Many ways to cause hand injuries are as follows

• Sports: High-impact activities end in falls or direct blows to the hands²
• Occupational accidents: In most cases, such injuries result from heavy machinery or repetitive jobs, acute or chronic, etc²
• Household chores: Simple activities like using ladders and using heavy utensils while making meals may cause injuries
• Road traffic accidents³

Symptoms

• Pain
• Swelling
• Tenderness
• Bruising
• Obvious deformities like misaligned or crooked fingers
• Inability to flex fingers or thumb
• Numbness 
• Restricted hand activity
• Weakness

Role of occupational therapy in hand injury rehabilitation

Occupational therapy makes a great contribution through the practice and further development of hand rehabilitation. The training, combined with physical, functional, psychological, and social components, prepares the professional to provide the necessary treatment. This allows patients’ hands to return from a dysfunctional to a productive state.

Assessment and evaluation

This includes:

Intake procedures

Therapists conduct physical examinations for range of motion, strength, and sensation in the hand. Some standardised tests and observational assessments evaluate the functional capabilities of the injured hand.⁴

Functional assessments

This refers to the patient's ability to perform activities of daily living to identify needs for intervention or specific areas of concern, thus guiding treatment planning. Tools such as the Functional Independence Measure (FIM) may provide some quantitative data on patients’ capabilities.⁴

Goal setting

Occupational therapists collaborate with each patient to establish realistic rehabilitation objectives based on the patient’s needs. In most cases, the goals often include improved restoration of certain functions and increased independence in doing everyday activities.

Treatment approaches

Treatment involves the use of various treatment techniques to restore hand function. Occupational therapy involves strategies related to pain management. 

Strategies related to pain management

These can include heat or cold therapy, electrical stimulation, and massage to reduce pain and discomfort. Therapists also teach patients self-management strategies for pain control.⁵

Range of motion exercises

These are important to improve flexibility, avoid joint stiffness, and maintain the overall range of motion. Therapists control the patient’s movement in specific actions to increase joint mobility.⁵

Strengthening exercises

After discomfort is minimised, the therapist may initiate strengthening exercises with the aim of building strength in muscles that help facilitate hand function. This may involve resistance and more functionally oriented activities using grip and dexterity.⁵

Sensory re-education

For patients with nerve injuries, re-education of the senses restores touch and proprioception. Techniques may include tactile stimulation and graded exposure to various textures.

Activities of daily living (ADL) training

In this, the therapist collaborates with the patient on exercises related to essential dressing and grooming, or modified cooking habits to ensure she can take on routine tasks within her capabilities. A trainee thus enhances skills coupled with heightened self-esteem and confidence.

Splints

Structural and immobilisation that provide support for healing to proceed and protect injured areas. Custom-fit splints have been proven to contribute towards increased comfort and excellent functional outcomes.⁵

Tools for adapted daily activities

Tools such as adapted utensils or adaptive grips may help the patient in undertaking his daily activities despite his injuries. New technological innovations can further support patients to become independent.

Manual therapy

Manual therapy involves the use of hands-on methods that improve circulation, reduce pain, and increase range of mobility to promote recovery. Techniques include massage, joint mobilisation, and soft tissue manipulation, among others.

Modalities

Modalities are used in support of rehabilitation. Some examples of modalities include:

• Heat therapy: It increases blood flow and relaxes muscles. This primes the hand for exercise
• Cold therapy: It decreases swelling and numbs pain. This is most valuable right after the injury
• Electrical stimulation: It enables muscle contraction. It may be useful in managing neural injury pain

Home exercise programs

Many therapists create individualised home exercise programs to extend therapeutic gains and encourage the continuation of treatment outside the clinic. The home exercise program is supported with clear, step-by-step instructions, and visual aids or video demonstrations can supplement learning.

Summary

This article will outline the essential role occupational therapy plays in rehabilitation cases involving hand injuries. Its effectiveness is summarised as it is important for restoring functionality and quality of life. Hand injuries are common and may occur from several sources, such as sporting events, occupational accidents, or even normal daily activities. For the patients’ betterment, occupational therapists support patients with many techniques of occupational therapy. These techniques are goal setting, pain management, strengthening exercise, activities of daily life (ADL) training, manual therapy, etc.