Fieldwork can be exciting and daunting at the same time. Taking everything you have learned in school and putting it to practice is no joke. Hand therapy adds a whole new dimension to this. Between the anatomy and physiology, special tests, interventions, diagnoses, treatments, splinting…it is easy to get overwhelmed before it even begins! Let’s talk through how to prepare for your level II fieldwork in hand therapy as an OT student.
KNOW YOUR ANATOMY
This is probably the most important tip. Everything you will do in hand therapy will stem back to anatomy. So learning your anatomy will be of most importance. When thinking about the anatomy, we want to learn the bones, muscles, tendons, ligaments, nerves and blood supply. Let’s start with the bones. Knowing the bones of the upper extremity is important for multiple reasons. When we are dealing with a fracture, knowing what bone was fracture, the type of fracture, surgical or non surgical, and knowing bony landmarks can help us as we treat our patients. When we think about the muscles, want to think about the A O I N,
or the Action, Origin, Insertion, and Nerve innervation of the muscles. What does the muscle do, where does it attach from and to, and what nerve supplies it? This is the foundation for hand therapy in my opinion. Knowing this will help you solve any of the problems you come across. For example, if a patient comes in with a dx of carpal tunnel syndrome, but is having symptoms in the ring and pinky fingers, knowing the anatomy of which nerve supplies innervation to these digits will help you quickly rule out carpal tunnel syndrome, as the median nerve (which is involved in CTS) does not supply innervation to the ring and pinky finger. So if nothing else, study your anatomy! I recommend the Trail Guide to the body workbook, as well as YouTube videos to help you with this. Write out the AOINs. Make a recording and listen to it on your way to fieldwork, while you are doing dishes or cleaning the house. Become one with the anatomy.
SPECIAL TESTS
Some referrals are easy to follow because it is a post surgical protocol or a specific diagnosis. But a lot of referrals will be for hand pain, wrist pain, finger pain, elbow pain, shoulder pain. It will be up to you to decipher what may be going on. Our job is not to diagnosis specifically, but special tests can point us in the right direction of what could be going on and how to treat said condition. Anatomy will tie into this as well, knowing which muscle, tendon, or ligament a special test is testing. There are special tests to rule in/out nerve involvement, tendinitis, arthritis, ligament laxity/damage/tears, tendon tears, bursitis, and more. I would recommend asking your CI what diagnoses they see the most and look up special tests specific to those diagnoses. This is something you will also learn “on the job” during your rotation, but studying ahead of time is a great way to get ahead for your rotation.
INTERVENTION
This is something again, you will learn “on the job,” but I always recommend looking up hand therapy interventions to get a general idea of what you will be doing during your rotation. Remember that interventions need to be tailored to the patient individually, but getting general ideas to get the creative juices flowing for your rotation is never a bad idea. Social media has become an avenue/tool for this.
You can check out IG, Tik Tok, YouTube, etc. for ideas.
DIAGNOSIS
This is a tough category because there are SO MANY diagnoses for the upper extremity. However, I always recommend my students to study fracture diagnoses for the hand, wrist, elbow, shoulder, carpal tunnel, cubital tunnel, radial tunnel, medial and lateral epicondyalgia, arthritis in the hand, elbow,
and shoulder. As your rotation goes on, you will learn more about each of these and other various diagnoses. You don’t need to know everything about them but knowing that carpal tunnel is with the median nerve while cubital tunnel is with the ulnar nerve is something you should know going into your rotation.
TREATMENT
When it comes to treatment, I always recommend my students learn what it is we can do for treatment. This means soft tissue mobilization, joint mobilizations, modalities, taping, etc. This is a broad one I recommend, don’t get down into the nitty gritty with this, just know the various modalities you will most likely use during your rotation.
SPLINTING/ORTHOTICS
You will learn more about this on the job, but knowing the general types of splints we fabricate will be good thing to study up on. YouTube is a great resource to watch fabrication videos on various orthotics. Learning the wrist cock up, forearm based thumb spica, radial based thumb spica, radial/ulnar gutter orthosis, resting hand orthosis, mallet orthosis are just a few you can look up and ask to practice during your rotation!
A Final Note
Okay, so right about know you are probably feeling overwhelmed after reading that. I know I was when I asked my CI what I should do to prepare for my rotation. One thing I want you to remember: You’re not expected to know everything,
YOU ARE A STUDENT.
Your job is to be willing and ready to learn, and getting a head start on this will not only impress your CI, but also set you up for success during your rotation.
ASK QUESTIONS.
We love students who are critically thinking during their rotation. This is the time to expand your critical thinking skills, and the more questions you ask, the more you will learn.
GIVE YOURSELF GRACE.
This is a hard rotation. There is a lot to learn. You are not going to know everything and that is okay. Give yourself grace and room to grow. Ask how you can improve during your meetings with your CI.
I hope this post was helpful! Share it with others who are going through a hand rotation, like and follow for more content!
