What Is a Certified Hand Therapist (CHT)?

A Certified Hand Therapist (CHT) is an occupational therapist (OT) or physical therapist (PT) who specializes in the treatment of upper extremity conditions. While OTs and PTs have distinctly different training and roles in rehabilitation, therapists with a CHT credential provide the same type of treatment, regardless of their background. CHTs work in hospitals, outpatient clinics, and inpatient rehabilitation centers.

This article discusses the conditions that are treated by CHTs, the training required, and the certification process.

Conditions

Certified hand therapists treat a variety of conditions of the musculoskeletal system and nervous system that affect the function of the hand and arm.

Examples include:

• Fractures (broken bones)
• Tendon injuries (such as tendon lacerations)
• Tendonitis/Tendinopathy
• Osteoarthritis
• Rheumatoid arthritis
• Traumatic/crush injuries
• Muscle strains/tears
• Amputations
• Birth defects
• Developmental disabilities
• Central nervous system conditions (such as traumatic brain injury or Parkinson's disease)
• Tumors or cysts
• Wounds
• Infections
• Ligament injuries
• Lymphedema
• Burns

Procedural Expertise

CHTs use a variety of treatment interventions to help decrease pain and improve function in people with upper extremity injuries or conditions. These can include:

• Range of motion, stretching, and strengthening exercises
• Modalities (such as ultrasound, electrical stimulation, and cold laser)
• Biofeedback
• Desensitization techniques
• Edema (swelling) management
• Manual therapy (mobilization techniques, massage)
• Wound care
• Return-to-work training (work hardening/conditioning)
• Fabrication of splints
• Prosthetics
• Scar management techniques
• Adaptive equipment
• Assistive devices
• Ergonomics training

Training and Certification

Before a person can become a certified hand therapist, they must first be a physical therapist or occupational therapist for a minimum of three years. During that time, the therapist must accumulate at least 4,000 hours of direct practice in hand therapy treating people with upper extremity conditions or injuries.

Once these qualifications have been met, the therapist must take a comprehensive test that focuses on advanced clinical skills and theory in the treatment of the upper quarter (the hand to the neck).

After a therapist becomes a CHT, they must continue to obtain continuing education and practice in the field of hand therapy to apply for recertification every five years.

There are around 6,600 CHTs in the United States and just over 7,000 worldwide. Of these, 87% are occupational therapists, while only 12% are physical therapists. One percent have dual licensing as both an OT and a PT.

Why See a CHT?

Occupational therapists and physical therapists are trained to treat basic hand conditions as part of their education. However, more complex injuries, such as tendon lacerations, crush injuries, and complex finger fractures require specialized interventions that follow specific treatment protocols. Certified hand therapists typically treat people with these types of injuries.

CHTs also have additional skills, such as the fabrication of dynamic splints, that general healthcare providers do not typically have. Because they treat complex injuries, CHTs often work very closely with hand surgeons, sometimes in the same office.

Appointment Tips

At your first appointment, your CHT will perform an evaluation. This includes a thorough history of your injury or condition, as well as a review of other medical conditions that could impact your healing process.

A physical exam is then performed, which often includes range of motion measurements and strength testing. For certain diagnoses, such as a tendon or nerve repair, your first visit might also include the fabrication of a splint out of thermoplastic material.

Your therapist will discuss your goals with you and develop a treatment plan, which might include several treatment sessions per week, as well as a home exercise program.

Treatment sessions usually last between 60 to 90 minutes, but this will vary depending on your specific needs. Duration of treatment also depends on your diagnosis; treatment can be as short as a few visits or last more than a year.

Summary

A certified hand therapist (CHT) is an occupational therapist or physical therapist who has undergone additional training in treating injuries and conditions that affect the upper extremity. Before a therapist can become a CHT, they must have three years of clinical experience and 4,000 hours of direct treatment of upper extremity conditions.

To obtain the CHT credential, a therapist must pass a comprehensive exam. CHTs treat various conditions that affect the musculoskeletal and nervous systems.

A Word From Verywell

If you've had an injury to your hand or arm, you can benefit from treatment by a certified hand therapist. Most insurance providers cover treatment by a PT or OT, which includes CHT services. Many insurance companies will cover this therapy without a referral from another healthcare provider, referred to as "direct access."

If you've had hand surgery, your healthcare provider will likely send you to a CHT for follow-up treatment if one is available in your area.