Hand Therapy After Surgery: What to Expect

Creator: Dr. Pedro Loredo
Published: 2026-04-27

By Dr. Pedro Loredo, MD · Hand Surgeon

Medically reviewed by Dr. Pedro Loredo, MD · Last reviewed: 2026-04-27

Hand therapy is the structured rehabilitation that often determines whether a hand surgery succeeds. A Certified Hand Therapist (CHT) is an occupational therapist or physical therapist with advanced training specifically in the hand and upper extremity. For surgeries that involve tendon repair, complex fractures, joint replacement, or significant scarring, the work the patient does with a hand therapist over weeks to months is as important as the surgery itself. This article explains who needs hand therapy, what a CHT actually does, the typical session pattern, and how the surgeon and therapist coordinate during recovery.

Who Benefits from Hand Therapy

Not every hand surgery requires formal therapy. Endoscopic carpal tunnel release, open A1 pulley release for trigger finger, and De Quervain's release usually need only a brief patient-led home program. The procedures and conditions that benefit most from supervised hand therapy:

Flexor tendon repairs (Zones 1 to 5): highly specific protocols with active and passive motion at controlled times. Moving too soon ruptures the repair. Moving too slowly causes adhesions that lock the finger in scar tissue.
Extensor tendon repairs: similar logic, with zone-specific protocols.
Fracture fixation with anticipated stiffness: distal radius fractures, finger fractures, and complex hand fractures often need 6 to 12 weeks of structured motion work.
Joint replacement (CMC arthroplasty, MP arthroplasty): protected motion in a custom thumb spica or hand-based splint with a graded therapy progression over 3 to 6 months.
Ligament reconstruction: scapholunate, ulnar collateral ligament of the thumb, and similar reconstructions need protected progression of motion and grip strengthening.
Complex injuries (mangled hand, replantation): the most intensive therapy courses, often 4 to 6 months of frequent visits.
Stiff hands from prolonged immobilization: any patient who has been in a cast for more than 4 weeks usually benefits from a few weeks of therapy to recover motion.
Postoperative complications: nerve compressions, complex regional pain syndrome (CRPS), tendon adhesions, and Dupuytren's recurrence all benefit from specialized therapy.

What a Certified Hand Therapist Does

A Certified Hand Therapist (CHT) is an occupational therapist (OT) or physical therapist (PT) who has completed advanced training and certification specific to the hand and upper extremity. The training requires at least 5 years of clinical practice, 4,000 hours in direct hand therapy, and a board examination. Most general OTs and PTs do not have this credential.

What a CHT does that goes beyond general therapy:

Custom splint fabrication. A CHT makes thermoplastic splints in the office during the visit, sized to your hand and adjusted as you heal. Resting splints, dynamic splints, blocking splints for tendon protocols, and night splints for stiffness all fall under CHT expertise.
Tendon glide protocols. Specific exercise sequences that move the tendon through its sheath without overloading the repair. The Duran, Kleinert, and Indiana protocols are examples used after flexor tendon repair.
Edema management. Compression wraps, elevation, retrograde massage, and contrast baths to reduce postoperative swelling that would otherwise stiffen the hand.
Scar management. Silicone gel sheets, scar massage, desensitization exercises, and modalities to soften and flatten the scar so it does not restrict motion.
Range of motion progression. Joint mobilizations, contract-relax stretching, and activities specific to the joints involved.
Strengthening phase. Progressive resistance using putty, hand grippers, and functional tasks.
Modalities. Ultrasound, paraffin baths, fluidotherapy, and electrical stimulation as adjuncts to active therapy.
Functional task retraining. Practicing the specific activities the patient needs for work and daily life.

A short reel from Dr. Loredo on tendon repair. View on Facebook.

The Typical Course of Therapy

The session pattern depends on the procedure, but a typical course for a moderate-complexity surgery looks like this:

Weeks 1 to 2 (acute phase): 2 visits per week. Focus on edema control, pain management, scar care after suture removal, and protected motion within the surgeon's protocol.
Weeks 3 to 6 (early motion phase): 1 to 2 visits per week. Active and passive range of motion, splint adjustments, scar massage, and home exercise program refinement.
Weeks 6 to 12 (strengthening phase): 1 visit per week or every 2 weeks. Progressive grip and pinch strengthening, return to functional tasks, work simulation if needed.
Discharge: when the patient has reached the goals (range of motion, strength, function) or when progress has plateaued. The patient continues a home program independently.

Tendon repairs follow a more intensive schedule, often 2 to 3 visits per week for the first 6 weeks. Joint replacements often need 4 to 6 months of total therapy. Routine fracture rehabilitation often resolves in 6 to 8 weeks of weekly therapy.

The Home Program: The Bigger Half of Therapy

Most patients are surprised to learn that what they do between therapy sessions matters more than what happens during the sessions. A typical home program prescribes 4 to 6 sets of exercises per day, each lasting 5 to 15 minutes. Patients who do their home program faithfully recover faster and to a higher level than patients who rely solely on the therapy visit.

The therapist's job during a session is to assess what the home program is achieving, identify the next limitation, adjust the exercises, fabricate or modify splints, and demonstrate new techniques. The patient's job between sessions is to do the work consistently. The session is the coach. The home program is the practice.

How Dr. Loredo Coordinates with Hand Therapists

For procedures that need supervised therapy, Dr. Loredo writes a detailed prescription that includes the diagnosis, the surgical procedure, the protocol to follow, the timing of motion progression, and any restrictions. The prescription specifies a CHT when the surgery requires advanced expertise.

The first therapy visit usually occurs at the first postoperative visit (between days 7 and 14, depending on the procedure). The therapist communicates back to the surgeon at key milestones: when motion progression is appropriate, when there are concerns about adhesions or rupture, when strengthening can begin, and when discharge is reasonable. This collaboration is essential for tendon repairs and complex cases.

We work with several CHTs and hand therapy practices throughout the DFW area, including practices close to our Grapevine office and convenient to where patients live. Patients who already have a relationship with a hand therapist can usually continue with that therapist if the protocols and communication work well.

What to Bring to Your First Therapy Visit

Make the first visit efficient by bringing:

The therapy prescription from Dr. Loredo
Your insurance card and identification
A list of your current medications
Comfortable clothing that allows access to the operative arm (short sleeve or sleeveless top)
Any splints, slings, or dressings you were given after surgery
Questions about home exercises, activity restrictions, and milestones

The first visit usually includes an evaluation, a measurement baseline (range of motion, strength, swelling), the initial home program, and often the first custom splint if one is needed.

Frequently Asked Questions

Do I really need hand therapy or can I just do exercises at home?

It depends on the surgery. Simple procedures like endoscopic carpal tunnel release, open A1 pulley release for trigger finger, and De Quervain's release usually do not need formal hand therapy. The home exercises and the standard recovery progression are enough. Procedures that benefit significantly from hand therapy include tendon repairs (flexor and extensor), fracture fixation with significant stiffness, joint replacements, complex injuries, replantation, ligament reconstruction, and any case with prolonged immobilization. The supervision by a Certified Hand Therapist is essential for safe progression of motion in tendon repairs, where moving too fast can rupture a repair and moving too slowly can lock the finger in scar tissue.

What is a Certified Hand Therapist (CHT) and why does it matter?

A Certified Hand Therapist (CHT) is an occupational therapist (OT) or physical therapist (PT) who has completed at least 5 years of clinical practice with a focus on hand and upper extremity, has logged 4,000 hours in direct hand therapy practice, and has passed a rigorous specialty board examination. The certification is administered by the Hand Therapy Certification Commission. Hand surgery rehabilitation is highly specialized, with protocols specific to each surgery and tendon zone. A CHT brings advanced training in custom splint fabrication, tendon glide protocols, scar management, edema control, and the timing of motion and strengthening progression. For tendon repairs and complex hand surgery, a CHT meaningfully improves outcomes.

How often will I have therapy and for how long?

Frequency varies by procedure. Tendon repairs and complex injuries typically start with 2 to 3 visits per week for the first 4 to 6 weeks, then taper to once a week, then to once every 2 weeks as motion progresses. Total duration ranges from 6 weeks for a routine post-fracture rehab to 4 to 6 months for a flexor tendon repair. The home exercise program is the bigger piece. Patients perform 4 to 6 sessions of home exercises every day. The therapy visits adjust the program, fabricate splints, manage edema, and progress motion based on what the home program is achieving. Most outcomes are determined by adherence to the home program, not by how many times a week the patient sees the therapist.

Will my insurance cover hand therapy?

Most commercial insurance and Medicare cover hand therapy when prescribed by the surgeon for a covered surgical procedure. Coverage typically includes a set number of visits per condition (often 30 to 60 visits per calendar year) with copay or coinsurance as defined by the plan. Workers' compensation cases are covered when the injury is approved. Pre-authorization is sometimes required for prolonged courses or for specific protocols. Our office helps coordinate the referral, the prescription, and the documentation so the therapy is approved without delay. Patients with high-deductible plans should ask the therapy office about per-visit cost up front, since the bills can add up over a long course.