Hello! At Hand Works, we extend a warm welcome to anyone grappling with pain, loss of function, or any diagnosed or undiagnosed injury or condition affecting the hand, wrist, or elbow, which could be hindering their quality of life.
We are an occupational therapy service specialising in the management of hand, wrist and elbow injuries and conditions. We have eight locations based around the Perth Metropolitan area with a team of highly experienced hand therapists focusing on the optimal outcome for our patients.
Hand therapy is a specialty practice area of occupational therapy, typically concerned with treating orthopaedic, plastics and neurological upper-extremity conditions, aiming to optimise one’s functional use of the hand and arm. At Hand Works, our occupation-based and patient-centred approach offers our patients an added dimension to their treatment through identifying the unique needs and desired outcomes of each individual. Our ultimate goal is to offer our patients a rehabilitation process that promotes healing centred around a return to meaningful activities, thus enhancing quality of life.
Being occupational therapist-owned provides us with a unique viewpoint on the conservative management of hand and upper limb injuries and conditions. Instead of relying solely on surgical interventions, this perspective allows for a focus on holistic care, functional outcomes and maximising one’s abilities to perform daily activities, work tasks and leisure pursuits.
Our approach highlights the significance of applying sound clinical reasoning skills, conducting comprehensive assessments, promoting rehabilitation and integrating adaptive strategies tailored to meet the specific needs and goals of individual patient.
The carpal tunnel is an area on the palm side of our wrist, formed by our small wrist bones and a roof of connective tissue. This tunnel houses nine tendons and a nerve, making it a very busy and compact part of our anatomy. If you bend your wrist forwards, or clench a fist, this can squash the nerve. With repetition, these movements can eventually compress or irritate the nerve, leading to numbness, pain, and weakness in the thumb, index and middle fingers.
This condition can be diagnosed by your doctor based on ultrasound imaging, otherwise Nerve Conduction Studies can be arranged as an alternative measure. That said, our hand therapists can assess the wrist prior to imaging and commence treatment straight away if warranted. When managed early, carpal tunnel syndrome can typically respond very well with non-operative treatment.
De Quervain’s Tenosynovitis occurs from repetitive movement of the thumb and wrist joints, e.g. repetitive lifting or gripping, high volumes of computer-based work or picking up/holding of a baby. Symptoms typically include inflammation of the two tendons that move the thumb upwards and outwards, causing radiating pain up the thumb side of the forearm and wrist. This pain tends to occur with tasks that involve downward or side-to-side twisting of the wrist.
Conservative treatment for De Quervain’s includes splinting, activity modification, tendon gliding exercises, taping and, once pain has settled, a gradual strengthening program to prevent re-aggravation of the tendons. If pain is still persistent after a period of conservative management, a corticosteroid injection or surgery may be recommended. Our hand therapists can assist with recommendations to a hand surgeon if this is required.
Most commonly affecting the ring and little finger, Dupuytren’s is a disease whereby the connective tissue in the palm of the hand gradually contracts and develops thickened cords/nodules that pull the fingers in towards the palm. Little is known about the cause and progression of the disease, however it is suggested that those of Celtic or European ancestry are at increased risk of developing this condition.
Generally, treatment is not required until you are unable to place your hand flat on the table or it limits your day-to-day function. Treatment options are limited to surgical interventions, in which your surgeon will discuss suitable options to improve your symptoms.
Post operatively, you will likely be required to see a hand therapist to assist with managing wound care, swelling, pain and finger stiffness. After the wound has healed and sutures removed (if required), your hand therapist will fabricate a thermoplastic orthosis to prevent your scar from tightening and further pulling your finger(s) down into the palm. Your therapist will also guide you through an individualised home exercise program to assist with scar management, finger movement and strength to optimise your return to meaningful activities.
Elbow fractures or dislocations usually occur following falls, high impact blows or sporting injuries, tending to be very painful and functionally limiting. Following such injuries, your doctor will most likely refer you for an X-ray and further treatment. At Hand Works, our therapists will be able to provide you with a custom-made waterproof thermoplastic splint to immobilise and protect the elbow joint throughout your recovery.
In the event of no fracture being detected, the ligaments and surrounding soft tissue in the elbow may still be injured in the form of a dislocation. In our rooms, our therapists can perform a number of tests to assess the stability and strength of your elbow and, if suitable, will manage your injury conservatively with a period of splinting, strengthening and proprioception exercises. If a high-grade injury is suspected, you may be referred on for further imaging and advice. If there is a significant fracture to the elbow, this will be treated surgically, followed by an extensive hand therapy rehabilitation program to regain your movement, strength and hand function.
Finger Dislocations occur due to a sudden force being applied to the finger, often seen in sporting injuries such as a ball striking a finger, forceful twisting injuries, and falls.
These can sometimes get misdiagnosed as a simple ‘jarred finger’ but might occur in ligament damage or to tear or in some cases cause the ligament to pull off a small piece of bone, resulting in something called an avulsion fracture. These injuries can take time to heal and, if not properly managed, may lead to long-term complications.
The goal of therapy in these cases are to increase the stability of the affected joint whilst maintaining movement and function of the finger. Once a thorough examination has been completed, an appropriate splint may be fabricated to help support the finger while the injured structures heal. This finger orthosis protects the joint from re-injury throughout your recovery, whilst also assisting to reduce swelling and pain. Your therapist may also provide you with specific finger exercises to reduce finger stiffness and ultimately improve your hand function and strength.
The term “fracture” or “break” are interchangeable when referring to bone injuries. These injuries often occur from falls, high impact blows, sporting injuries, crush injuries, or twisting forces. Common associated symptoms include pain, redness, swelling, stiffness and difficulty moving impacted joints.
To assess for a broken bone, you will be required to have an X-ray or a CT scan of the injured site. Depending on the severity of the fracture, your doctor may recommend immobilisation in an orthosis/splint or a surgical opinion.
Simple fractures that are minimally displaced can often be managed in a thermoplastic orthosis/splint. Our hand therapists are well-trained in the creation of waterproof, custom-made thermoplastic splints for a wide variety of upper limb fractures, which can be remoulded throughout the recovery process as your swelling improves.
For fractures requiring surgery, a thermoplastic splint may also be made pre- or post-operatively to immobilise and protect affected joints. Throughout your treatment, our hand therapists will continue to liaise with your treating doctor/surgeon to ensure you receive the best possible functional outcomes from your splinting and rehabilitation.
Hand stiffness can occur from a number of reasons such as swelling and scarring to muscle and joint tightness due to a period of immobilisation. At Hand Works, our therapists are able to perform specific assessments to determine the cause of your stiffness and provide you with a tailored exercise program to improve your function. You may also be fitted with an exercise splint or a splint to improve your range of motion. Depending on the severity of your condition, your therapist may also recommend further imaging to rule out other potential causes of ongoing stiffness.
Ligaments are short, tough bands of connective tissue that hold our bones together to form a joint. Some of the commonly injured ligaments in the wrist include the Scapho-Lunate ligament and Triangular Fibrocartilage Complex. These bands of tissue play a very important role to both stabilise our joints and inform the brain of our body awareness in order to improve our coordination. In our wrist, we have multiple small bones interconnected by ligaments. When you ‘sprain’ your wrist, you may have injured one of these ligaments, resulting in pain with specific movements, actions, or weight-bearing activities. Occasionally, a ‘clunking’ feeling may also occur with particular actions.
If you have experienced a ligament injury or have ongoing wrist pain, our hand therapists can perform a full clinical assessment of your wrist in our rooms. If a high-grade injury is suspected, your doctor may also refer you for an MRI. Depending on the severity of the condition, our therapists will be able to provide you with a wrist orthosis/splint to protect and immobilise the ligaments throughout recovery. After a period of splinting, our therapists will guide you through a comprehensive home exercise program focusing on mobilising and strengthening the wrist to prevent re-injury.
The nerves that provide movement and sensation to our upper limb begin at our spine and travel down through our shoulder, elbow, wrist and then hand. Along this course, nerves can become trapped and compressed among various muscles, ligaments and tendons. When this happens, we may experience weakness in the muscles of our hand and arm, as well as symptoms of altered sensation such as numbness, tingling, burning or pins and needles.
We have three different nerves in our arm: Median, Ulnar and Radial. Your doctor may refer you for further examination of the nerve, and our hand therapists will be able to conduct a series of assessments to distinguish which nerve is trapped or compressed and where the compression site is. Depending on the outcome of the assessment, a conservative treatment plan may involve splinting, exercises and other treatment modalities to help with your condition.
Tendons on the front and back of our hands enable us to bend and straighten our fingers and wrists. As a result, injury to a tendon may make it very difficult, or even impossible, to move our hands. Aggravated or inflamed tendons usually require a period of rest and immobilisation, a process often assisted by a custom-made thermoplastic orthosis/splint fabricated by our therapists. This immobilisation period is then followed by a program of active mobilisation and strengthening as required.
Tendons that are completely torn will often require surgical intervention in order to repair the ends back together. Following surgery, our therapists will guide you through your rehabilitation process, providing you with any necessary splinting and advice. This post-operative process usually involves wound management, splinting and an exercise program to allow the tendon to rest, recover, and regain strength over time.
Volar plate injuries, often referred to as a “jarred finger,” are common finger injuries that occur when the ligament on the palm side of the finger is damaged. This usually happens when the finger is forced to bend backward, such as when a ball strikes the tip of the finger. In some cases, the force can cause the ligament to pull off a small piece of bone, resulting in something called an avulsion fracture.
Signs of a volar plate injury include swelling, bruising, and pain at the middle joint of the finger. These injuries can take time to heal and, if not properly managed, may lead to long-term complications such as stiffness and inability to fully straighten the finger. Treatment often includes the use of a finger orthosis to protect the injured ligament, as well as exercises to maintain mobility and promote healing during the recovery process.
Osteoarthritis (OA) is the gradual breakdown of the soft protective tissue, known as cartilage, that cushions the joint. It typically occurs over time with gradual ‘wear and tear’ from repetitive hand use however can also be influenced by family history and previous joint injury. As the cartilage thins and deteriorates, the bones begin to rub against each other which can cause pain, swelling, and stiffness.
One of the more commonly affected joints is the base of the thumb. When the base of the thumb is affected by OA, this can result in pain with simple tasks such as turning the key, chopping vegetables, and hanging out the washing.
Whilst there is no cure for OA, treatment focusses on managing symptoms and preventing further joint damage. Hand therapy can include a combination of splinting, gentle exercises, stretching, massage, activity modification, and the use of assistive devices. Early intervention and a tailored treatment plan can significantly improve quality of life and hand function in people with OA allowing them to manage the condition effectively without surgery.
Trigger Finger occurs when the tendon that bends the finger becomes irritated and no longer passes smoothly through its pulley that holds it close to the bone. Tendon inflammation reduces the space for the tendon to glide through the pulley which can cause the finger to catch or lock in a bent position. This can result in pain, stiffness and difficulty straightening the finger. It typically occurs with repetitive or forceful gripping activities however medical conditions such as diabetes and rheumatoid arthritis can also increase your risk.
Hand therapy can include a combination of splinting, gentle exercises and activity modification to reduce pain and allow the tendon to glide freely again. Most people experience improvements within 6-8 weeks of therapy however if symptoms persist, your therapist may refer you back to your doctor for further treatment options, such as corticosteroid injections or a referral to a hand surgeon.
Ganglion cysts are smooth fluid-filled sacs that typically form near a joint or tendon. They are commonly found in the wrist and fingers however can also occur in other parts of the hand and may look like swelling or a round lump, change size, cause discomfort or pain, and potentially limit movement at the affected joint. The cause of ganglions is not well understood however they are believed to form after an injury or due to mechanical changes in the joint or tendon and can act as a mechanism to provide stability to the affected joints.
In most cases, ganglion cysts are harmless and don’t require treatment however if they cause pain or discomfort hand therapy can be helpful in managing these symptoms. A combination of splinting, gentle exercises, and activity modification can assist in managing ganglion cysts. In some cases, if the cyst is persistent or large, a hand surgeon may be consulted to discuss options like aspiration (draining the cyst) or removal.
Tennis Elbow (Lateral Elbow Tendinopathy) is a condition usually caused by repetitive motions of the wrist or hand, which can happen at work, during sports, or even with everyday tasks. Symptoms include pain on the outside of the elbow, pain with gripping and lifting heavy loads, and weakness in the upper limb. This occurs because the common extensor tendon (the tendon that connects the muscles which extend your wrist and fingers) becomes inflamed from overuse and can sometimes lead to small tears in the tendon.
Hand therapy helps reduce pain, prevent further damage, and get you back to your normal activities. Treatment may involve rest, along with splinting, bracing, or taping, followed by specific exercises to gradually strengthen the tendon. While tennis elbow can take several weeks or months to heal, your therapist will guide you through strategies to manage symptoms and prevent re-injury.
Golfer’s elbow (Medial Elbow Tendinopathy) is a condition similar to tennis elbow, but it causes pain on the inside of the elbow. It affects the common flexor tendon, which connects the muscles on the front of your forearm to your elbow. These muscles are responsible for bending your wrist and fingers. When the tendon is overused, it can become irritated and develop small tears, leading to pain and stiffness. Golfer’s elbow is often caused by repetitive strain on the hand and wrist, which can happen during work, sports, or even everyday tasks.
Hand therapy helps reduce pain, ease irritation, and restore function. Treatment typically includes rest and a gradual rehabilitation program designed to safely strengthen the tendon. If you’re experiencing elbow pain, your therapist will perform a thorough assessment to help identify the cause and create a treatment plan tailored to you.
The Cubital Tunnel is a small passageway made by the inner elbow bone and soft tissue structures, and the ulnar nerve runs through this tunnel. Cubital Tunnel Syndrome occurs when pressure is applied to the ulnar nerve as it passes through the elbow. The Ulnar Nerve provides sensation and function to the ring and little fingers. When this nerve is compressed, it can cause pain, tingling, and weakness. Pressure on the Ulnar Nerve can be caused by activities that involve repetitive elbow movements or prolonged elbow flexion.
Conservative treatment for Cubital Tunnel Syndrome includes splinting, activity modification, nerve gliding exercises, taping and gradual strengthening program. In some cases, if symptoms persist despite therapy, surgical intervention may be considered to decompress the nerve and provide long-term relief.
A Mallet Finger is an injury to the tendon that straightens the tip of the finger. This typically happens from a sudden, forceful bending of the fingertip, for example during ball sports. This results in the inability to straighten the tip of the finger, leaving it bent.
Treatment usually involves wearing a splint that keeps the fingertip straight for 6-8 weeks, and gentle exercises may be introduced as your finger heals. With proper care, a Mallet Finger generally heals well, though it’s important to follow your treatment plan to ensure the best recovery.
Radial Nerve Palsy (also known as Saturday Night Palsy or Wrist Drop) occurs when the Radial Nerve, which controls wrist and finger extension, is damaged or compressed. It can result from trauma, prolonged pressure, or repetitive strain. People with extreme cases of Radial Nerve palsy may present with an inability to actively extend the wrist, or digits and may have a weakened grip.
If you suspect radial nerve palsy, your therapist can assist you by making functional splints that allow you to continue to engage in your everyday activities whilst supporting the nerve to recover. Your therapist will also assist with clinical assessment and make recommendations for further imaging or surgical intervention if it is required. With early intervention and proper therapy, most people can regain function and manage symptoms effectively.
Intersection Syndrome is a condition that affects the tendons at the back of the hand, specifically those responsible for extending the wrist and thumb. These tendons pass close together, and at one point, they cross over each other — hence the name “intersection.” When these tendons become inflamed, it can cause pain, tenderness, and discomfort, particularly with wrist or thumb movement.
This condition is often caused by overuse of the wrist and thumb, leading to irritation and swelling at the intersection point of the tendons. If you suspect you have Intersection Syndrome, our therapists will conduct a thorough clinical assessment to determine whether it is indeed Intersection Syndrome or potentially another tendon-related injury. If diagnosed, your therapist will work with you to create a personalised treatment plan, which may include custom splinting, education on how to protect the injury during daily activities, and rehabilitation exercises aimed at strengthening the muscles and tendons.
Rheumatoid Arthritis (RA) is an autoimmune condition that causes chronic inflammation in the joints, leading to pain, swelling, stiffness, and over time, joint damage. While RA can affect any joint in the body, it most commonly impacts the hands, wrists, and fingers.
Your therapist can assist in managing RA by providing splints to help prevent joint deformities, recommending exercises to improve joint mobility and strength, and offering guidance on pain management techniques and activity modifications to reduce strain on affected joints. Early intervention and ongoing management are essential for controlling symptoms and preventing long-term damage. With the right care, many people with RA can maintain an active and functional lifestyle.
