When people hear we have a Certified Hand Therapist on staff, they often ask whether that's simply physical therapy for a smaller body part. Fair question. The answer is no, and the difference matters a great deal for how your hand recovers, especially after surgery. Below is what sets hand therapy apart and what it looks like at our North Palm Beach clinic, plus when to ask for it by name.
By The First Rehabilitation Team · Reviewed by Dr. Dave Kashuba, Ph.D.
The hand is a precision instrument
Your hand and wrist pack dozens of small structures into a very tight space: tendons gliding through narrow tunnels, small joints that have to line up just so, and nerves responsible for the finest motor control in your body. A little scar tissue in the wrong place can mean the difference between a full grip and one that never quite closes. Rehabilitation at that scale needs specialized training.
“Our original tool”
Dr. Matt Butler, MD, a fellowship-trained hand and upper extremity orthopedic surgeon with HSS, joined Dave and Mike on Pain 2 Power Episode 16 and described his job about as simply as anyone could. “I take care of people's arms,” he said, mostly the elbow, wrist and hand. When the talk turned to what drew him to the hand in the first place, he named the intricacy, and then this: “That's how we all interact with our environment… something that people take for granted until it starts bothering them.”
A minute later he called the hand “our original tool,” the one we use for working, for art, for everything in between. Think about your own morning. Keys, buttons, a coffee mug, a steering wheel on US-1, the phone you check all morning. You don't notice any of it until one of those things starts to hurt.
Who ends up needing it
Pretty much everyone, eventually. Dr. Butler listed the people who come through his door: “elderly people with degenerative hand problems, workers that injured their hands at work, artists that have repetitive stress injuries.” In the Palm Beaches you can add golfers with sore thumbs, pickleball players with cranky elbows, and the gardener who can't open a jar anymore and is quietly annoyed about it.
What “CHT” actually means
A Certified Hand Therapist is an occupational or physical therapist who has completed years of hands-on hand and upper extremity practice and then passed a national certification exam. It's one of the most demanding credentials in rehabilitation, and it exists because hand recovery is unforgiving. Move too soon and you can compromise a surgical repair. Move too late and you lose motion to stiffness.
That's why hand surgeons tend to refer their post-operative patients to a CHT specifically, rather than to general rehab. They want someone who knows the anatomy they just repaired and the healing timeline it's on.
Who leads ours
Our hand therapy program is led by Laura Drumm, MS, OTR/L, CHT, CLT. She's an occupational therapist by training and a certified hand therapist, and she's also a certified lymphedema therapist, and swelling after hand surgery is on the list of things the program treats. Laura's work covers everything from custom splinting to post-operative tendon protocols, and patients travel to us for it from across the county, including West Palm Beach and Palm Beach.
It fits the rest of the clinic, too. Our founder, Dr. Dave Kashuba, Ph.D., OTR, is himself an occupational therapist and has been treating patients since 1991, and our occupational therapy program runs in the same building. So if your hand problem is getting in the way of dressing, cooking or work, those daily tasks can be worked on alongside the hand itself. (If you've ever wondered where PT ends and OT begins, we wrote about the difference between physical and occupational therapy.)
Custom splinting, made in-clinic
One of the most visible differences is the splint. In clinical language it's an orthosis: a support that protects or positions a hand, wrist or finger while it heals. Splints can be custom or ready-made. Our hand therapy program fabricates custom splints right here in the clinic.
Each one is molded to your hand for your specific condition. It holds the healing structures at the angle that stage of recovery calls for, and it gets adjusted as healing progresses rather than worn unchanged until the next appointment. When you're recovering from surgery, it's built to your surgeon's protocol. For carpal tunnel, a custom night splint that keeps the wrist in a neutral position while you sleep is often part of the plan. For an arthritic thumb, it might be a supportive splint you wear during the activities that flare it.
Coverage for custom splints varies by plan, so our front desk checks what yours covers before you come in. It's a quick phone call that saves a surprise later.
Timing is everything
After a tendon repair or a fracture, tissue healing follows a biological timeline, and the calendar on your fridge doesn't get a vote. Protocol-driven hand therapy walks that line, in coordination with your surgeon.
After a tendon repair
Repaired tendons heal on a strict schedule and the margin for error is small. Post-operative timelines vary widely by procedure: some repairs begin protected motion within days, while others need a period of immobilization first. We work from your surgeon's protocol, fabricate any splint to it, and stage motion and strengthening to the tissue. That's also why we'd love to hear from you before your operation, or just after it, so your plan and any splint you need are ready on schedule.
After the cast comes off
The bone healing and the hand working again are two different problems, and the second one is usually why they end up with us. Stiffness, swelling and lost grip are the real obstacles once the cast is off. Expect the early work to be about motion and swelling before it's about strength, with the pace set by what's healing rather than by a fixed number of weeks.
What hand therapy treats, and how
Most people arrive with a symptom, not a diagnosis: numbness that wakes them at night, a thumb that hurts every time they pinch, a finger that catches. The evaluation sorts that out. Here's roughly what care looks like for the conditions we see most.
| Condition | What care usually involves |
|---|---|
| Carpal tunnel syndrome | Custom night splint, nerve and tendon gliding exercises, workstation and activity changes; a surgical consult recommended plainly if it's needed |
| Arthritis of the hand and thumb | Joint protection technique, targeted strengthening, a custom supportive splint and smarter ways to do the tasks that hurt |
| Tendon injuries and repairs | Surgeon's protocol, a splint built to it, then motion and strengthening staged to the healing tissue |
| Hand and wrist fractures | Protect what's still healing, restore motion gradually, then rebuild strength and dexterity for work and daily life |
| Trigger finger and nerve conditions | Splinting, graded motion and activity changes, conservatively or after surgery |
| Tennis elbow and the forearm | The whole upper extremity is in scope: hand, wrist, forearm and elbow |
| Swelling and stiffness after surgery | Treated as part of the plan from the start, rather than something to wait out |
The elbow counts too
Your arm works as one connected chain, so a certified hand therapist's scope runs from the fingertips to the elbow. Tennis elbow is the classic example. Dr. Butler described it as almost a rite of passage in middle age: the tendon that anchors the forearm muscles to the bone starts to fray, and most people who get it have never played tennis. Most cases settle down. The ones that land in his office first, he said, usually get sent to Dave, and he puts Dave's success rate at about nine out of ten. Dave was just as complimentary in the other direction: “he'll do whatever it takes to keep you from having to do surgery.”
Dave walked through what that looks like on his side: active release technique, blood flow restriction training, and dynamic cupping, sometimes with an actual sink plunger. (Yes, really. You'll see one in our office.) Mike was the test case, since Dave had treated his elbow before the show. “I've had like zero pain since you did it,” Mike said. “I forgot that even happened.” For the stubborn cases that don't respond to therapy, Dr. Butler described cleaning out the worn tendon and adding a collagen patch originally developed for the shoulder.
Thumb arthritis
This is the topic Dave booked Dr. Butler to talk about. Pain at the base of the thumb that flares with pinching, opening and twisting is common, and Dr. Butler said basal thumb arthritis develops in almost every woman and many men. Conservative hand therapy is one of the most effective options for it. When surgery does become the answer, he explained that the standard operation removes a small wrist bone called the trapezium and is followed by six to eight weeks immobilized and months of rehab, and that pinch strength never fully returns. He now also offers a thumb joint replacement, built like a dual mobility hip, which he said has been used in Europe for about fifteen years and was newly FDA cleared. Which route is right for you is a conversation for you and your surgeon. Either way, the hand that comes out the other side needs rehab.
Surgeons and therapists, working hand in hand
We don't diagnose, and we don't do surgery. Surgeons operate; we rehabilitate. What makes a hand recovery go well is how closely those two halves talk to each other.
That relationship has been a theme on the show since the beginning. Back in Episode 2, hand and upper extremity surgeon Dr. Tom Saylor, M.D., talked through the surgical side of restoring hand function, from carpal tunnel and tendon repairs to complex reconstruction. Dr. Butler and Dave send patients back and forth today. When a patient's evaluation here suggests they need a surgical opinion, we say so plainly and coordinate with their physician rather than keep them in therapy. When a patient comes from surgery, we work from the surgeon's protocol and stay in touch with their office.
If you've got hand surgery coming up, here's what helps us have everything ready:
- Your surgeon's name and the procedure, ideally before the operation
- The referral and protocol from the surgeon's office
- Every insurance card you carry, so we can sort out which pays first
- The two or three everyday tasks you most want back, from buttoning a shirt to gripping a golf club
How to get started
Whether you need a referral depends on your insurance plan. Post-surgical patients typically arrive with a referral and protocol from their surgeon already. If you're coming on your own for something like carpal tunnel or arthritis, call and our front desk will check whether your plan requires a referral and help arrange one if it does. Hand therapy is covered like other medically necessary therapy under Medicare and most major plans we accept, and we verify your specific benefits, including any rules about custom splints, before your first visit.
That first visit runs about an hour, one-on-one, and treatment usually begins the same day. The hand therapy section of our FAQ covers recovery times and coverage in more detail, and our hand and wrist pain page walks through the most common symptoms.
If you're facing hand surgery or dealing with carpal tunnel or arthritis in your thumbs, ask to see our certified hand therapist. Call First Rehabilitation of North Palm Beach at 561-624-4263 to book an evaluation, or request an appointment online.
This article is general information, not medical advice. Every situation is different, so please consult a qualified professional about yours.