Hand Therapy

About Diamond Bar Hand Therapy

Diamond Bar Hand Therapy is a branch of Gary M. Souza, PT & Associates, an outpatient physical therapy practice serving the Pomona and San Gabriel Valleys and Northern Orange County since 1981. Diamond Bar Hand Therapy opened in 1996 with Liz Souza, DPT, CHT as the primary hand therapist.

What to Expect

Diamond Bar Hand Therapy has many treatment options available to treat upper extremity conditions. Our evaluation and hands on care are our most significant tools in the rehabilitation process. We work closely with your physician to develop the best treatment options and follow the appropriate protocol for your condition.

Evaluation: Your initial evaluation will consist of a thorough assessment of your upper extremity and neck. Objective measures will be taken to provide a baseline to evaluate your progress and may include strength tests, sensation, range of motion measures, grip/pinch tests, and function movements.

Stretching/Mobilization: Hands on techniques will be employed to increase the mobility of tissue such as muscles, tendons, joints and scars to allow proper mobility and function.

Scar Management: The hand has very complex movements that require precise and intricate motions to occur between many structures such as tendons, joints, and nerves. Manual stretching of post-operative/or traumatic scar tissue is essential to restore these intricate mechanics and is provided by hands on techniques by your hand therapist.

Swelling Management: Scar tissue and swelling are factors that impair the rehabilitation process. Techniques to manually assist the body to remove excess fluids from around an injury will allow improved function, faster healing and fewer symptoms. Additional application of compression through a Jobst Pump, glove or wrap, and special taping may be employed.

Conditions We Treat

Hand therapists have extensive training on the mechanics and impairments of a variety of upper extremity conditions. Many symptoms in the hand may have their origin in the neck, shoulder, forearm or the wrist and hand itself. A thorough evaluation of these areas is essential for a successful rehabilitation program.

Click on a topic below for descriptions of some of the many conditions we treat:

Common Conditions

Fractures

Physical therapy for a fracture of the arm, wrist, or hand is generally started once the fracture has been determined to be stable. Initially, the goals for physical therapy are to decrease any swelling that is still present and to restore range of motion. Strengthening exercises are introduced as tolerated to prepare the extremity for functional use.

Mallet Finger

Mallet finger is a traumatic disruption of the extensor tendon where it attaches to the bone. This results in a loss of extension at the last finger joint. This condition can often be treated non-surgically with custom splinting and a gradual reintroduction of movement.

Dislocations

The proximal interphalangeal joint of the finger is the most commonly dislocated joint in the hand. Depending on the type of dislocation and the associated trauma, these injuries are treated either surgically or non-surgically. Loss of extension at the joint is very common following this type of injury. Physical therapy is often extensive and involves custom splinting and manual techniques to restore joint motion.

Crush Injuries

When fingers are crushed between objects, significant boney and soft tissue trauma can occur. Physical therapy goals are to decrease swelling, restore range of motion, and decrease hypersensitivity. Pain or hypersensitivity can be a significant problem in these types of injuries due to the number of nerve endings located in the fingers.

Sprains and Strains

There are many different injuries to the ligaments and muscles of the hand and wrist. Physical therapy for these injuries involves a thorough evaluation of the hand or wrist and then development of a treatment plan to address the specific injury. Special consideration is given to the patient’s functional limitations so that the patient’s therapy is customized to meet their individual goals.

Post-Surgical Conditions

Fracture Fixation

Some arm, wrist and hand fractures require internal or external fixation devices in order to stabilize the fracture for proper healing. Internal fixation can be in the form of pins, plates or screws and external fixators are devices that place pins through the fracture site but are attached externally to a device that maintains tension on the fracture. Physical therapy is generally started within the first two weeks following surgery and involves range of motion until the fracture is determined to be healed. Once healed, strengthening exercises are introduced.

Nerve Repair

Following any type of nerve repair care must be taken to avoid stretching the repaired nerve ends which might cause tension and lead to scarring. This could interfere with the nerve achieving functional innervation of the muscles. Therapy focuses on regaining and maintaining full mobility of the joints and soft tissues while preventing hand deformities which may occur due to inactive muscles while the nerve is healing. Custom splinting is generally required to protect the nerve repair.

Tendon Repair

Tendons are the tissues that attach muscle to bone. If a tendon is severed, the muscle is unable to create its desired motion. Therapy following a tendon repair is crucial to achieve the maximum potential for motion and strength. Protective splinting and very specific exercises are used to protect the repair while allowing joint movement. These exercises depend on the specific location of the tendon laceration/rupture.

Tenolysis

This surgery may be indicated if, despite appropriate surgery and postoperative therapy, the patient’s active motion is significantly less than what can be achieved passively. Tenolysis involves removing any scar tissue which has adhered to the tendon preventing it from gliding. Motion is started within the first few days following surgery to prevent adhesions from reforming.

Trigger Finger or Trigger Thumb Release

Locking or clicking in the thumb and finger that does not resolve with splinting and physical therapy may require a surgical release of the pulley that restrains the flexor tendon. Following surgery, physical therapy involves manual techniques to prevent scar tissue formation around the tendon and restore normal tendon glide of the flexor tendons.

Wrist Surgery

There are many different surgical procedures performed to repair or debride damaged structures within the wrist. The wrist, with its complicated interaction of the carpal bones and ligaments, requires stabilization initially and then manual techniques to restore the maximum achievable range of motion. Strengthening exercises are introduced as indicated depending on the procedure.

Joint Replacements and Reconstructions

The joints of the fingers and thumb can be successfully replaced or reconstructed if there is significant damage due to arthritis or traumatic injury. Custom splinting is a key element to successful rehabilitation following these surgeries. Once allowed, manual techniques and exercises are used to restore range of motion and prepare the hand for functional use.

Referrals

Our patients are usually referred by a physician or surgeon, including general practitioners, orthopedists, hand surgeons, neurologists, rheumatologists, or plastic surgeons.

Patients may also make an appointment for an evaluation prior to implementing a treatment. Please contact us for more information by emailing info@gmspt.com

About Liz Souza, DPT, CHT

Dr. Souza’s interest in hand rehabilitation developed from a growing need in our area to treat complex upper extremity conditions. As an avid tennis player, Dr. Souza has a strong interest in the mechanics of the neck, shoulder, elbow and their relationship to wrist and hand function.

Dr. Souza graduated Summa Cum Laude from UCLA with a bachelor’s degree in Kinesiology. She received her master’s degree in physical therapy from Chapman University in 1990. She was invited to attend USC as a member of the first Doctor of Physical Therapy class and graduated with her DPT in 1996. She became a Certified Hand Therapist in 1995.

Dr. Souza continues to teach hand and upper extremity courses and has been an adjunct professor of physical therapy at the University of Southern California since 1996.

Diamond Bar Physical Therapy has been providing rehabilitation for patients with upper extremity injuries since 1981. Our “hands-on” approach assures a therapist will evaluate and treat your condition with care and compassion. Successful rehabilitation comes from a skilled and thorough evaluation, open communication with the patient and physician and bringing all hands together in partnership.

Explore our website for more information on our clinic and the types of conditions we treat and the kind of treatments we can offer.

Any questions for our hand therapist? Email info@gmspt.com

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