Complicated hand injuries are never easy to treat. I want to share with you a little bit about what I do and how I work with patients who’ve experienced something truly complex, like an amputation with a severe fracture. This particular case involved a patient who had a really challenging hand injury, and I’ll walk you through some of the details we faced together.
You can also check out the full video here:
The Initial Injury and Surgical Challenges
This hand was truly complicated. The patient had an amputation and a severe fracture. You could actually see the scars on the side. We worked for a really long time, really hard, to avoid doing a trigger release surgery. But we ended up needing it anyway.
He had to undergo a release of all three. That was a big moment. And one thing I want you to really pay attention to—because this often gets forgotten—is that when you’ve had a major injury, hand pain doesn’t just come from visible scars. Sometimes there’s deep scarring and adhesions underneath the skin that can cause problems even when there’s no visible cut.
Learning to Feel What Can’t Be Seen
As a therapist, you’ve got to learn to feel with the tips of your fingers. You can feel the difference in texture. His hand was really swollen before, and after some time, we were finally able to get the wrinkles back.
If you look closely, the tissue will be nice and soft, but then you hit this area and—bam—it gets stuck. You can feel it. It gets stuck. If I run my fingers across the area. The metacarpal connects to the proximal phalanx, and along the sides of these bones run the intrinsic muscles—small but important muscles that help with fine motor control in the hand. After a severe injury, these muscles can sometimes get stuck due to scarring or tight fascia. Whether it’s the skin, connective tissue, or something deeper causing the restriction, the key issue is that the structures aren’t gliding smoothly like they should.
This kind of sensory work is something I cover in my online occupational therapy courses. It’s all about learning the feel of the hand, not just what you see on a chart.
Manual Techniques and Tissue Rebalancing
A lot of people tend to focus on the middle of the hand during rehab—not present company, of course—but yes, we all do it. They spend all day working just in that area. All the muscles end up pulling the proximal phalanx forward, which throws everything out of balance.
One thing I do from a manual perspective is distract and pull it back. You wouldn’t believe how much better that feels. Not only does it reduce tension on the top of the hand, but it also allows you to work smarter: shorten the extensor structures and stretch the flexors at the same time.
These tight zones often go unnoticed unless you truly evaluate the whole structure. When treating someone, you’ve got to ask: how’s the bone alignment? How’s the joint sitting? Are the tendons and muscles moving the way they should? Or is there an imbalance?
This level of assessment is critical if you’re learning how to become a certified hand therapist. You can’t just memorize anatomy—you have to feel it, test it, and understand it functionally.
Looking Beyond Range of Motion
Yes, we test for flexion, extension, abduction, and adduction. However, between the proximal phalanx and the metacarpal, we also need to look at ligament function. The MP joint needs stability and offers passive motion, too. That’s what people forget.
So if I hold the metacarpal and rotate, I can feel the difference: one direction is tight, the other is looser. Ligaments might not be visibly damaged, but they can still be tight in just one direction. That’s something to keep in mind when you’re studying for your hand therapy certification.
Never Ignore Skin, Fascia, and the Bigger Picture
You must always look beyond just the site of injury. Check all around it—skin, fascia, the whole hand. Otherwise, pain persists. And more importantly, the hand remains imbalanced.
When that happens, the intrinsic muscles become too tight, the flexors overwork, and every time the patient squeezes, they’re squeezing with the whole hand instead of just the fingertips. That’s how the pain cycle continues.
As a certified hand therapist, you need to understand how everything plays together. You’re not just treating a joint or a muscle—you’re retraining the hand to work in balance.
Final Thoughts: Working with Complex Hands
Working with a complex or chronic hand requires you to look at everything: skin, joints, tendons, ligaments, balance, and even how someone squeezes. Our goal is always to avoid unnecessary surgeries, but if surgery happens, then we focus on achieving the best outcome possible.
So if you enjoyed this video or found value in this breakdown, hit the like button, subscribe, and leave me a comment with any questions you have. I love making more videos to help you crush it in the hand therapy world.
Learn with Hand Therapy Secrets
At Hand Therapy Secrets, I help occupational therapists sharpen their skills and grow their confidence. Whether you’re looking to meet the certified hand therapist requirement or you’re just getting started on your journey, we’ve got tools, mentorship, and real-world training for you.
Our hand therapy mentorship program is designed to help you understand hands-on a deeper level, beyond what books can teach. Let me guide you toward becoming the confident and knowledgeable clinician your patients deserve.
Visit Hand Therapy Secrets and take your next step toward mastery.
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