How to Evaluate Any Hand Patient That Comes Your Way!
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[00:00:00] If you're an occupational therapist looking to develop your skills in hand therapy. This podcast is for you, your host, Hoang Tran occupational therapists, and certified hand therapists turned serial entrepreneur with her own therapy clinic in Miami. Hoang is an author and successful coach helping occupational therapists get jobs, develop their skills and become certified hand therapists so they can become experts in their.
Hoang worked with occupational therapists from across the United States and around the world. She talks about everything from hand therapy, skills, career development, leadership skills, money, mindset, and business. You two can become an expert certified hand therapist, business owner, and have more choices in your career.
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Thank you so much for your time for your attention. I love it. We're gonna actually dive into some evaluations today, so if you have any questions on what to do with evaluations I think my therapist shared her story. Her [00:01:00] question, which was like, what to write in a certain. An evaluation.
So I might cover a little bit of that. So tell me what's good. Let me know where you're coming from, just where you're tuning in from. Type it in the chat somewhere and let me know where you're tuning in from. Let me know if, are you guys working in hand therapy? Who's working in hand therapy?
Who's doing, working in private hand therapy? Private hand therapy anyone working on private hand therapy? Sometimes private hand therapy clinics want you to document just a little differently than if you were working in a hospital base type of place, right? So depending on the setting in which you work, you might have somebody who's a little bit more.
like very specific. You have to write it this way, you have to write it that way. I know that when I was working in a hospital system, it was very [00:02:00] particular. And one thing that I wanted to do when I started in the hand therapy mentorship program was really just to. A framework, really create an easy framework that you can always go back and think.
Think about when you are evaluating a patient for the first time. See, so you see that blackboard right there? Back there? Let me see if I can angle it just a little bit for you. This is, I was going through with
was going through with my own therapist, like how you think through a particular case, right? So we all get different cases and an evaluation is an evaluation. It's an evaluation, and it really doesn't matter if it's a, if it's a finger, a wrist. An elbow, a shoulder, you're gonna get so many different types of diagnosis for, that comes in, you might have something that's post-surgical, you might have something that's chronic, right?
Chronic meaning like they [00:03:00] had surgery, but now it's been like a while, months, years. You might have someone who's non-surgical who really always comes down to. Like breaking it down right? Breaking it down, and essentially a certain amount of planning, right? So this board here that I was going through was the planning stages.
So when you get a, when you get a prescription, like for example, I'm gonna use this very particular example. This person came in with a distal radius fracture, right? Distal radius fracture. About two years old. So you have to start to wonder, this is a dis radius fracture that's two years old, and what do we need, what do we know about it?
It's two years old and that she has contractures. Contractures. So automatically I'm thinking there's a stiff hand somewhere. When you have somebody who has a wrist injury, [00:04:00] what are essentially the complications that. Go through, right? Their risk could get really stuck, their fingers could be really stuck.
Their thumbs might be really stuck or painful. And then you might, they might not be able to sate, right? Some generic thinking in terms of what might be the potential. So it's an orf. So they had an open reduction internal fixation. So when you're thinking about it you're gonna break it down to what potentially are the problems?
Is it a bone problem, is it a ligament problem? Is it a tendon muscle problem? So those are essentially part of that framework. So you wanna break it down into is it a bone problem? Is there something going on in terms of the bones, in terms of. Joint congruity. Join congruity. You're looking at range motion.
You wanna look at all of them. Just like I said, we're looking at [00:05:00] shoulder, wrist, fingers, and forearm. I always 100% always look at the shoulder, so I would encourage you guys to always look at the shoulder too, especially when they're chronic. I always say this, when someone has a really hard time sup eating and pronating, they're gonna really get stuck in their shoulder and they're not gonna be able to like internally rotate.
Cuz when they turn their palm up and turn their palm down, look what they're doing with their shoulder, right? So they're compensating. Someone who can't move their wrists is the same way. They're gonna start to compensate with their shoulder and also someone with their fingers. So in your mind, when you're getting an evaluation, this is the first time you're seeing someone.
You want to have that mental play. And this is the mental play that we're, that I'm talking through, right? And you wanna think, what's their diagnosis? What are their potential problems? So that when you see them, you already know, what am I looking for? What am I looking for? What am I looking for? So if I'm already looking for someone's wrist, gonna look at their wrist, you're gonna look at their fingers, [00:06:00] look at their shoulder, right?
And then you can determine. Do they actually have joint stiffness? That might be a problem. The other problem you might be looking at, which is strength, right? Which is muscles and tendons. So if they're muscle and tendon problem, it might be that they're lacking strength. So they're coming to you for a reason.
In hand therapy, occupational therapy, there's, there're probably, if there's major motion problems, there's gonna be strength problems. So then you're breaking it up and saying, okay, what type of strength problems could they have? Could they have strength problems to assess that they can't grip? They can't grip. Their tendons might be sucked, their tendon might not glide as well. If it's a dis radius, can they not wait there? Can they not stand up and put weight through their wrist or push off or push the door or anything like that? Some weightbearing types of. And then lifting. People use their hands [00:07:00] and lift heavy things.
So you're taking a look. It's not just grip, it's not just wrist, but forearm, right? You're looking, lifting requires forearm and shoulder. So in terms of strength, you wanna have an idea of all the things that you're looking at. So everything that relates back to. And that type of motion is their ability to have their flexor tendons be able to glide flexor tendons can glide, and then in order for flexor tendons be able to glide, your extensor tendons have to give, right?
So your extensor tendons have to give and then everything has to be able to pass through that. , right? So then you have to think about all the risk muscles, right? The risk of sensors or flexors potentially. So when you're getting any kind of diagnosis that comes, that's how I would encourage you to break it up.
If you look at it, you want to always think about what that [00:08:00] person may potentially be coming in with so that you're, when you see it, you're really not. When you see it, you're not surprised. We're gonna have some kind of range motion problem and then that's how you break it down. So then you can think, okay, depending on what the problems are, this is where I can put my focus.
Another complication of an or i f of a wrist problem besides the stiff fingers besides strengthening and stuff, might be potential nerve issues. Especially if they had surgery. , they might have some nerve issues. And so it's something that you wanna look at. You wanna look at the median nerve for sure is the easiest one to look at, right?
So a lot of times people have disre fractures and you see right here, they had a carpal tunnel release just in case they would have some kind of nerve issue, but other nerve issues can come into play as well. All the nerve issues can come into play with any kind of risk, injury, postsurgical and that kind of stuff.
The radial [00:09:00] nerve can come into play. Basically the little short branch, superficial branch or the radio nerve that kind of comes in thumb. So anyone who's had a split maybe on too long or anything like that, has some numbness there. So these are all the essential. Potential problems that you want to anticipate.
So when someone's coming into you, one of the first things you wanna think about is why are they there? Why are they there? So as soon as they come in, you start to observe. Are they writing with their right hand? Are they writing with their left hand? How are they moving? That kinda stuff. Then the second part is their.
So here's, it's not just about past medical history, it's not about the date of injury and the date of surgery and stuff like that, but it's really what have you done? What have you done? What are you continuing to do? Especially it's chronic, right? What have you done? What are you continuing to do?
What's still bothering you? What's so bothering you? If [00:10:00] they're chronic, there's something that's bothering them. As soon as you find out what that problem is, you wanna go right to it or you wanna go right to it. Oh, so I, one of the things that I like to do is I like to scan before I take any kind of measurements, I like to scan and see what's your emotion what's bothering you the most today?
So I can know like how. You know where to focus, right? If they're a dis radius fracture, but their wrist moves, why would I focus on their wrist, right? So what one of the things that I like to do is I like to just do a general scan. So let me see how your fingers move. And already you can see all of the complexities of it, if they're compensating, if they're really tight.
if they have pain. You can definitely ask all those questions, right? You have time? Then I'll just say oh, just move your wrist like this. Just turn your palm up and down. Thumbs up, elbow straight. Let me take a look at how your shoulder's moving. [00:11:00] All this, just a general guideline so that I can find out.
From my observation where I want to essentially put my focus in, this woman came in really stiff figure wise. So I already knew I needed to focus on her fingers, right? So then I ask her, so tell me what's going on? What brings you, why are you here? What brings you into therapy?
right? So it's a two year old problem. What have you've done? What are you still continuing to do? What actually still, what actually helps, you know what actually helps and what doesn't help it. It's very important, right? Depending on what they've done in the past, it really can help you determine what you can do next.
So you get all their story and find out what is the key problem that they have so that you can know how to fix it. You take your measurements, your range of motion measurements, your grip strength measurements. If there's some numbness or anything you can take [00:12:00] what's it? Simon's Weinstein, test for sensation, but you wanna make sure that you are getting a certain.
Objective measurements, but you want to make sure the subjective is really important. What is it that you would like me to be able to help you with? They're gonna tell you it's pain. No one's gonna tell you range of motion. Nobody's gonna say ranger there. I can't make a fist. Okay, great. You know what, you find, you have to find out what they do remember.
So it's not just ADLs, but. work in leisure as well. So what are you having a hard time doing around your house? Obviously she came in with a hand like this, but she was completely independent. She was working, she was back at work. She was working, but she was just working light duty because she couldn't really make a full fist.
What is the one thing that you're having the most trouble with, that if I could really help you, it would make such a big difference. So [00:13:00] sure enough, it's, her fingers are really tight, they're really painful, and she just doesn't feel strong. Agree. So at least you have a place to focus, right?
So it's gonna be her fingers. So why does that help? Because when you go to write, can you go to
When you go to write their evaluation, you want to then start going, it's kinda a soap note, right? So note, so these are your measurements. These are, this is the easiest part. Because you're taking their grip measurements, you're doing all that good stuff, right? Subjective is relatively easy too because they're telling you what they want.
Like I want to make a fist without pain. And the plan is however many times you think that they need to. The assessment [00:14:00] part, this is what Elena was asking a lot about, is, ah, assessment is really the key part of the evaluation, right? Once you've gotten there, once you know why they're coming to you.
You have their story and you've broke, broken down those things that you need to do now you need to write why. Why are they there to see you and why should they keep coming to see you? So that's really the biggest and the most important part of assessment. They show a benefit from. You patient would benefit from you coming, from coming in to see you so that you can help them with X, Y, and Z.
This is the part where you get to summarize everything that you found out. This person has really stiff, fingers. She can't really work, it's [00:15:00] going to become a problem that the fingers gets different and stiffer. Now, as a chronic issue, this is as a chronic issue, what people wanna know, the patient the the payers, or, whatever.
Usually it's a patient. What they wanna know is it possible for you to be able to help them? Is it possible? Is it possible for you to help them if they present with a lot of stiffness in the fingers? That has also presented with some residual stiffness in the rest of the joints, a certain amount of pain, decrease strength due to the fact that the joints are what's the likelihood that you can help them? So I'm a big believer in, getting the most out of what you have, and that people have a lot of potential, right? People have a lot of potential. And so part of the assessment is done after [00:16:00] you've treated them and after you've worked on their, worked with them a little bit to see, okay, from the time they came in to the time they leave what have they benefitted from, right?
So that's really important. So when you write this, when you write the assessment, It's going to be about, patient, what, presents with these problems and they present with these problems. What was I gonna say? They present with these problems and the severity of, their issues.
And what is the likelihood of you being able to solve it for. This is also a great place where you could write what you're recommending as well. Patient presents with severe stiffness. She's already using X, Y, and Z at home. Patient would benefit from, let's say you're recommending a splint, you're recommending some kind of apparatus.
It would be a great place that will help [00:17:00] support the therapy service. What else would we say? What did we say about her? We said patient would benefit from from OT services, to address the residual stiffness that she has. There's some moderate sickness, but that loosens up during treatment which was the case with.
And then that's pretty much it. But a lot of times where people are having the issues with the assessment that I was having the discussion around was that sometimes you don't think that you can do it, and so it makes it really hard to summarize. But let's just pretend that if you could do it, how would you summarize it?
So a patient comes to you and they are feeling, they've got stiffness, if they've got weakness, if they have pain, you're essentially in the assessment writing man, they really have potential, to get better. Does anyone have questions around that? So one of the things that I always like to do is I always [00:18:00] like to talk it out first.
Think it out first so I can know what to expect. And then when you're carrying out the evaluation is one of the most important things that you have to ask is why are they there? What do they need from me? People are just not coming to therapy willy-nilly. They're looking for something might take you a minute to find, it might take, it's gonna take you a minute to help them.
They're usually coming in. For a reason, and it's our job to find out what it is so that we could really help them. Sometimes it doesn't, it's not always apparent, right? But that's why we wanna keep doing what we need to do in that first evaluation so that. They'll come back for the second visit and the third visit and the fourth visit, right?
Because we don't get a chance, we don't get a chance to help people if we [00:19:00] are, if we don't sound and we're not clear about what we're able to do to help them. If she came in and her main problem was a stiff hand and you're sitting there massaging her scar, She may not feel the benefit of that therapy session because we didn't focus on the thing that she wanted us to focus on.
So that part is so important. And sometimes, unfortunately, it's forgotten because sometimes we're only looking at the paper, oh, dis radius fracture. So we think, oh, we need to focus on the wrists or something like, But she's, we have to, in that evaluation, we have to find out exactly her problem, and then we have to state what her problem is, no matter how obvious.
Wow. Your fingers are really stiff. [00:20:00] I know, right? I know. Thank God you're here. Is that what you want me to work on? Cuz I'm, this is what I'm seeing. It looks really, it feels really stiff. Yeah, it's really stiff. And I just, I don't know what to do to get it better. Great. You're here. Let's work on it today and then we're gonna see how it feels at the end of the session.
And then the thing that we wanna look for is how it feels the next. All right. Want you to pay attention how it feels the next day. Now, I know it's gonna get stiff, right? So you have to tell them what to expect. I know it's gonna get stiff again. Here's what we're looking for. We're looking for small increments of change, small increments of improvement.
Chronic problems don't get fixed. I don't care how great you are, [00:21:00] chronic problems, especially finger stiffness, take time. We need to tell our patients that, right? So in your mind, this is essentially what you're gonna write, but more importantly, it's about what you're saying to them. So that.
They can believe and trust you in order for you to have an opportunity to help them the next visit. Patients usually come in with a lot of anxiety and things on their mind that they want to get off their chest in the beginning. Sometimes it helps to just introduce yourself and say, so what brings you into therapy today?
And it gets them to tell me. Exactly. It gets them to tell. But remember that
the first thing that they tell you [00:22:00] isn't always the thing, right? But what you say in response and what you do in response to that is what helps to bring them back the second time and the third time, and part of our job at the evaluation. is essentially to set expectations. If we're not setting expectations, in a way, like if we think that we miraculously just help people, like with no effort that's what they want.
But if we don't reframe that for them, they're gonna think that, somehow they're getting. , whatever it is that they think that they're getting right. And a lot of times when it comes to chronic stiff issues, it takes a while there. There's nothing wrong with saying, this is gonna take a little bit of time, but here [00:23:00] is what I would like for you to look for.
Here are the things that I'm looking for and I'd love for you to pay attention to too. The evaluation is so important. and it really does set a cadence to what the next several visits will look like. Now we work with a lot of a variety of people. So some people come in because they're told to come in and they're gonna come in until they're not told anymore.
Two, they're gonna come in because they made a decision to come in. So you have to know how they're coming. So that you can have the appropriate types of conversations. Cause they're just told to come in. They're just coming in, right? And then sometimes it looks and feels easier, like they're so committed, but they might not be that committed.
They're just told to come. And it makes a difference because what I see a lot is that therapists are working really frustrated. [00:24:00] Why? Why am I not getting this? Why? How come they're acting like that? . But in the evaluation it's really important to, determine certain things, determine people's level of commitment.
Determine where what people think is possible. Cause if they don't think it's possible for them, they're not gonna keep coming to you. So part of that evaluation so much is really about getting to know them and what they want, but before they come in and you getting to know them and what they want before that is that you have to have a breakdown and a thinking in terms of what you should be expecting and what your plan is on to do.
Cause you don't wanna come, you don't want. To get there and see somebody and be like, holy shit, what do I do now?[00:25:00]
you can think that you look so good, but body language is, it's really key. Body language is big. People see it, people sense it. And we can't take that stuff for granted. You. , this is what we do. We look at people's body language all the time. We're looking for little nuances here and there. So if we're doing it, they're doing it too, right?
So essentially that was one, one case that we had that came in very vague, right? And I don't know about you, but we get a lot of referrals. We get a lot of people who reach out to us just directly without referrals, and we have to have a certain idea of what that person is going to look like and present like when they come.
And it's extremely helpful especially what, regardless of whether you're a new therapist fresh outta school, [00:26:00] whether you've been working for a while, whether you're just now getting into hand therapy, whether you're experienced. , it helps to be able to go and look through and say, okay, what are they coming in for?
What might their particular problems be? How do I anticipate those types of issues? So then I know exactly where to look and what to measure, and questions to ask, and already start thinking what's possible, what kind of treatments are possible, right? What's the. Appropriate plan based on this pre-assessment.
It's like a pre-assessment of the assessment. So this is one of the things that I like to do with my staff inside the program. And we talk about different scenarios and stuff like that, and people can come on and bring in their cases and we can go into much more detail in terms. , [00:27:00] not just why they're there, but you know what you actually need to do to get progress, to get results.
At the end of the day, people don't wanna keep coming to therapy no matter how much they can come if they're not getting results. All right. Any questions? Anything else?
What's going on? Where's everyone coming in from? I appreciate you being here on a Saturday. It's nice outside. It's beautiful. Let me see. I see a couple people. Thanks for joining me. What are you guys up to today? Oh, so many people. So from Philly. Hey, Meg from Philly. I went there once, actually I went to God tried to get into OT school there and they said no, I dodged a [00:28:00] bullet.
Stayed in Florida. What are some of your challenges? Rainy day? New York. Oh, New York. I love New York. There's a place in New York. Best bagel. Oh my God, so good. My best friend and I still dream about that. Super bagel . We decided to split the super bagel , because we were gonna go eat in two hours, so we're like, we don't need our own bagel.
And then so we, we split the bagel and we're like, this bagel is so good. We shouldn't have split it, but. It was too late. The line was huge. It was really long. Apparently it's a really, hotspot. We're like, oh, it's okay. We're gonna come back on a Sunday before we leave, and we're gonna hit that spot again before we go.
Sure. We'll get there on Sunday. It was closed. Now it's just another excuse to come up to New York. I've been dying to get up there so yeah, it's a great day in, in Miami, Florida. It's always good [00:29:00] sunshine, good weather. It's warm, it's hot. I to turn the AC on always here. The office . I was like, God, getting sweaty.
So I hope this has helped in terms of, how to just help you if you're struggling with how to approach how to approach new valves and or any kind of crazy eval. Cause not everything is not everything is, like protocol, right? Not everything is like by the book. We had so many crazy cases.
And we had two literally two. It's a bilateral hand case. And the prescription, the guy didn't even know what was going on. Like he knew he hurt himself and had the surgery, but they didn't know. And the prescription was just as vague tendon repair. And sure enough came in both hands wrap.
Huge wound issues, right? So we can anticipate those things. Okay. Could it be a flexor tendon? Could it be an sensor tendon? What's the story? [00:30:00] How did the injury happen? Oh, it must potentially must be a flexer tendon. Could it be at the finger level or the wrist level or the forearm level?
And then, so you can keep those things in mind if it's fresh. Oh, they said it was stitches. Okay. Prepare your stuff because of its stitches. It might just be simple to complex, right? And so it was complex, 2.5 centimeter tunneling in the palm. So yeah, Stephanie gotta come to Miami with nice weather, year round
All right, ladies and gentlemen I hope to, this is the last, this is the last live of the year. Thank you so much for being here with me in 2021. I am so ready for 2022. I, we have an exciting year next year. [00:31:00] Every year is exciting. I think every day and every week and every year that we get to be around, thank goodness be around helping people, it's definitely a blessing.
I'm happy to be here at hand. Therapy Secrets and Therapy Secrets I'm in currently in my clinic, which is Hands-On Therapy Services. Sometimes when I make videos, I forget . I have to change shirts. I'm like, okay, hold on. Then I gotta change change what company I'm talking from . And some of my patients follow me on this side.
Hello, you're following me on this side. And some who are students go from every which way, but but yeah, no thank you. I'm still gonna be putting out video. Videos once a week on YouTube, so Oh. We're so close to 3000 followers. If you guys have not subscribed to Hand Therapy Secrets on YouTube, please do me a huge favor and [00:32:00] subscribe.
I always like to see those numbers tick up. And one of the videos re back that we released is a really inspirational video from one of my members, Nicole. So I'll go and watch. She talks about how she passed and became a ch h c this year. Super proud to be a part of her journey.
Super proud to know her and I hope that you guys get to watch that as well. So every week, once a week, hopefully more we'll be putting out videos. My team is helping to make sure that we are consistent. Putting out videos for you guys, sharing some of our knowledge. And if you're looking for more help, then ask me about the programs that we have available.
All right. We've got hand therapy mentorship that we meet every Thursday. If you are looking to If you're looking to become a certified hand therapist in 2022, I know [00:33:00] people. I love you. Thank you, Andrew. We're looking for people in California all over the place, all over the world. A certified hand therapist.
right? So looking forward to helping you. If you're on your journey send me an email, send me a message, and we'll make sure that you get started so that there's no point waiting. Today is the same as tomorrow. It's the same as January 1st. Like now is the best time. To get started.
People are like, oh, but the holidays, you have so much time in the holidays, please. You got someone cooking for you. You're driving somewhere. There's so much that you could do. There's no, once you make that decision, . Once you make that decision to commit to yourself and become that c ht, then everything after that should be about like, what are the action steps that I need to take to make that happen?
Because if you wait, oh, I'm gonna wait. It's like saying, oh, I'm, let me wait until [00:34:00] I I'm wait until I get fit and then I'm gonna join that gym. Now I'm gonna look good. , right? It doesn't make sense. If you're ready to commit, then you wanna take massive action, right? And hopefully we can be along that journey with you to help you take some massive action.
All right, thank you guys for being here, for joining me. Peace out 2021 and I'm ready for you guys in 2022. Have a great holiday season. Bye bye. I'm gonna end.
Hey, thanks for listening to Hoang's world podcast. If you are brand new to the hand therapy world, head over to my website, www . Hand therapy secrets.com, where you can get started with some of our free guides and paid programs for both OTs and PTs diving into the world of hand therapy. Or if you've been listening for a while watching on our YouTube channel and you think you could benefit from developing and moving your career further along [00:35:00] in hand therapy, reach out to me and my team at info @ Hand therapy.secrets.com and tell us exactly what you're looking for, By the way, if you know someone who could benefit from today's show, please share.
Thanks. See you on the next episode.
