Hands at Work: What Hand Therapists Bring to Occupational Medicine

Written by:

Alison Gilmore MS, OTR/L

VHSF Fellow ‘25

When I decided to shift my career toward specializing in hand therapy, I eagerly began searching for hand therapy jobs in my area. I was fortunate to come across an occupational medicine clinic looking for an occupational therapist, and I quickly found myself immersed in the world of worker’s compensation. It didn’t take long to recognize just how vital hand therapy is within the occupational medicine system.

According to data from the U.S. Bureau of Labor Statistics (2020), musculoskeletal disorders accounted for nearly 30% of all injury and illness cases resulting in days away from work in 2018. Occupations most at risk include manufacturing, construction, skilled trades, warehouse and material handling, mechanics, food processing, healthcare, and office-based desk jobs. In my practice so far, the most common injuries I encounter include crush injuries, fractures, sprains, strains, tears, lacerations, and cumulative trauma disorders.

Upper extremity injuries can significantly impact a person’s health, well-being, and work status. Many of my patients transition to light or modified duty when available. However, many labor-intensive jobs simply don’t have such positions, meaning patients may be out of work for weeks or even months depending on injury severity and recovery progression. Factors that influence return-to-work outcomes include dominant-hand involvement, number of days off work, job satisfaction, and level of support from coworkers and employers (Hosseininejad et al., 2023).

As an occupational therapist in this setting, my primary role is to assess and treat upper extremity injuries with the goal of helping patients return to work as safely and efficiently as possible. I work alongside an incredible team of occupational medicine providers, including MDs, PAs, and PTs, and I’ve learned how essential consistent communication is with my referral sources. One of the unique benefits of our small clinic is how easily I can meet or message the referring provider. This constant collaboration ensures we’re aligned on patient progress, and my input helps guide appropriate work restrictions and release to full duty.

Hand therapy in occupational medicine often mirrors traditional hand therapy settings, but there are key differences that make it distinct. Like most hand therapists, my treatment sessions include therapeutic exercise, neuromuscular re-education, manual therapy, modalities, and attention to psychosocial factors. One area I hope to expand into is custom orthotic fabrication. Our facility currently offers only prefabricated splints, and I’d love to bring custom options to our clinic.

One of the most rewarding parts of my job is designing occupation-based interventions tailored to each patient’s work demands. As an occupational therapist, this feels incredibly natural. For example, I might have first responders, such as police officers and firefighters, practice dragging weighted dummies and climbing ladders. For construction workers, I like to wrap a weighted cuff around a dowel to mimic hammering and have them strike an exercise ball. Patients consistently share that these simulations help them feel more confident returning to full duty after practicing real-word tasks in a controlled environment.

Beyond treating injuries, I also have the opportunity to provide pre-employment testing through a program called WorkSTEPS (2025). This comprehensive exam includes a medical history review, physical assessment, and job-specific task testing to ensure candidates can safely perform essential job duties. In this way, I’m not only helping injured workers recover – I’m also helping prevent injuries before they occur. Some companies have reported a 50% reduction in musculoskeletal injuries within the first year of implementing WorkSTEPS.

Working as an occupational therapist specializing in hand therapy within an occupational medicine setting has been incredibly rewarding. Hand therapists are essential for delivering comprehensive care in this environment. Our expertise in activity analysis, occupation-based intervention, and upper extremity anatomy makes us a valuable part of the team. I am especially grateful for the Virtual Hand to Shoulder Fellowship and Dr. Mirella Deisher for preparing me for my first role in hand therapy. The knowledge and guidance I have received from this program has given me the confidence as I continue growing in this exciting field.

References:

Hosseininejad, M., Javadifar, S., Mohammadi, S., & Mirzamohammadi, E. (2023). Assessment of the relationship between the return to work and the severity of work-related upper limb injuries using the whole person impairment. Chinese Journal of Traumatology, 26(2), 77–82. https://doi.org/10.1016/j.cjtee.2022.11.001

U.S. Bureau of Labor Statistics. (2020, May 1). Occupational injuries and illnesses resulting in musculoskeletal disorders (MSDS). U.S. Bureau of Labor Statistics. https://www.bls.gov/iif/factsheets/msds.htm

Employee Testing Resources. WorkSTEPS. (2025, January 27). https://worksteps.com/services/employee-testing-resources/