If you’re working with hand cases and you’re just not really sure what to do, well, stay tuned. We’re going to discuss a case today.
My name is Hoang Tran. I’m an occupational therapist and certified hand therapist. Inside my mentorship program, my students have the opportunity to send me questions about their cases. Today, we’re going to discuss a case that involves an injury leading to thumb and hand pain.
If you’re looking to advance your career, you may also be wondering about hand therapy certification and what it takes to specialize in this field. I’ll share some insights on that too.
The Case: A Sudden Injury Leading to Numbness and Tingling
One of my students sent me this question:
“I wanted to ask a question about my patient. She’s a 44-year-old preschool teacher, and she’s having hand and thumb pain and numbness. A student she was holding on to suddenly fell to the floor, and ever since then, she started having numbness and tingling in her hand and arm area. Everything looks good in terms of range of motion—she has a lot of mobility—but she continues to have muscle and nerve pain. They did an ultrasound, but afterward, her hand was cold to the touch, and you could see the veins more clearly.“
What’s Really Going On?
Is this really a hand case? That’s what I want to encourage you to think about.
If someone has numbness and then gets an ultrasound, and suddenly their color changes, think about the position they were in during the ultrasound.
For example, if you place someone’s arm outstretched on a table for an ultrasound, consider how that position might be affecting their circulation or nerve symptoms. Positioning matters. Be mindful of how you position your patients during evaluations and treatments.
Understanding Nerve Pain and the Source of Injury
When you hear about numbness, it’s always a nerve issue. But where is the problem? The hand? The elbow? The shoulder? Or could it be coming from the neck?
If you’re treating a hand problem but can’t get rid of the symptoms, you need to look at the bigger picture.
Thinking Beyond the Hand: Where is the Root Cause?
Let’s break it down:
- If someone holds onto a child and suddenly gets pulled, there’s a lot of traction—not just at the hand, but at the elbow and shoulder as well.
- Nerve issues are felt distally (in the hand), but the actual problem is often proximal (closer to the body).
- The biceps play a huge role because they originate in the shoulder, cross the elbow, and insert into the radius. If someone’s arm gets pulled, the biceps are actively working to stabilize. If you only focus on the hand, you might be missing the real issue.
How Do You Treat This Type of Nerve Injury?
Instead of just stretching the area, think about how you can gently compress the nerve to let it relax. The goal is to put the joints back into better alignment and strengthen the muscles and nerves so they function properly.
Here’s what I do in my mentorship program:
- I encourage my students to look beyond the hand and check the shoulder and elbow.
- I emphasize the role of the biceps and its connection to shoulder, elbow, and hand function.
- I teach a framework to help therapists identify nerve issues and treat them effectively.
If you’re interested in how to become a certified hand therapist or want to understand the certified hand therapist requirements, I break down the process to help you get started.
The Problem with Traditional Hand Therapy Approaches
In many cases, hand therapists are told to only treat the hand and wrist. But the reality is that nerve pain and injuries often start higher up in the body.
I see this all the time with work injuries. Many patients are failed by the system because their treatment is too limited. If their symptoms aren’t improving, the real issue might not be where the pain is—it might be above that area.
Final Thoughts: Don’t Be Afraid to Look Beyond the Obvious
If you’re treating hand problems and struggling to see results, don’t be afraid to look beyond the hand.
There’s a pattern in nerve injuries, and when you understand how the shoulder, elbow, and hand work together, you can solve these cases faster.
If you want to learn more about how to think through your cases and develop a clear direction for treatment, I teach all of this inside my mentorship program.
Got questions? Leave a comment below. And if you want to work with me, check out the links below.
Watch the Full Video for a Deeper Dive
If you found this discussion helpful, you’ll want to check out my full video breakdown of this case. In the video, I go into more detail about:
- The key mistakes therapists make when evaluating nerve pain
- Why looking at the shoulder and elbow is critical in hand therapy cases
- Simple strategies to test and treat nerve-related pain effectively
You can watch the full video here: Is This Really a Hand Case? Understanding Nerve Pain in Injuries.
If you enjoy these case discussions, make sure to subscribe to my channel for more in-depth hand therapy insights!
Want to Advance Your Hand Therapy Skills?
If you’re a therapist looking to improve your ability to assess and treat complex hand and nerve cases, I can help! At Hand Therapy Secrets, we provide expert guidance through our hand therapy mentorship program, where I work closely with therapists to build confidence and skills in hand rehabilitation.
We also offer online occupational therapy courses designed to help you advance your career and develop a deeper understanding of hand therapy. Whether you’re preparing for certification or just want to refine your treatment strategies, we’ve got a program to support you.
Explore our programs today and take your hand therapy career to the next level!
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The material contained on this site is for informational purposes only and DOES NOT CONSTITUTE THE PROVIDING OF MEDICAL ADVICE, and is not intended to be a substitute for independent professional medical judgment, advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions or concerns you may have regarding your health.
