Evidence Based Hand and Upper Extremity Protocols

Evidence Based Hand and Upper Extremity Protocols is a comprehensive manual with over 70 therapy treatment protocols for the most common surgical and nonsurgical diagnoses of the upper extremity.
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This manual is in a week-by-week format that is easy to use. Each protocol is based on the most current medical evidence and is uniformly outlined with indications, contraindications, recommended weekly therapy visits, and surgical outcome limitations. Many of the diagnoses have more than one protocol to choose from to appeal to all physicians.

An excellent manual to provide therapist, physicians, and students an easy step by step treatment guide of over 70 of the most common surgical and non-surgical protocols. Each protocol cites evidence along with the authors 34 years of practical clinical guidance to provide the best possible outcome. You will not find another treatment manual written by a therapist that has evidence for every protocol.


Table of Contents:



swanson MP arthroplasty (Rheumatoid or Osteoarthritis)
swanson MP arthroplasty (Osteoarthritis)
Swanson PIP arthroplasty (Volar Approach)
Trapeziometacarpal Joint Arthroplasty/Trapeziectomy (osteoarthritis) 


Total Elbow Arthroplasty 


Total Shoulder Arthroplasty

Biceps Rupture

Partial Distal Biceps Tendon Rupture (non-operative)
Distal Biceps Tendon Rupture (operative with hinged elbow brace) 

Dupuytren's Disease

Surgical Release
Open Palm or McCash Technique
Collagenase Enzymatic Injection 

Extensor Tendon Injuries


Zone 1 and 2
Zone 3 Acute Closed Injury or Closed Boutonniere
Zone 3 and 4 Repair (Static)
Zone 3 and 4 Repair
Zone 3 and 4 Repair (Static)
Zone 5- 8 Repair (Static)
Zone 5- 7 Repair (short arc of motion)
Zone 4 - 7 Repair (immediate controlled active motion, ICAM)
Nonrheumatoid Sagittal Band Closed/Acute Injuries (Sagittal Band Bridge)
Nonrrhumatoid Sagittal Band Closed/Acute Injuries (static)
Sagittal Band Repair (dynamic)
Nonrheumatoid Sagittal Band Repair (Sagittal Band Bridge)
Sagittal Band Repair (Static)


Zone 1 (Static)
Zone 2 (Static)
Zone 3-5 (Static)
Zone 5 (Static)
Short Arc of Motion
Extensor Tenolysis

Flexor Tendon Injuries


Modified Duran
Modified Kleinert
Early Active
Staged Flexor Tendon Reconstruction
Pulley Reconstruction/Repair


Modified Duran
Modified Kleinert
Flexor Tenolysis 

Ligament Injuries


Ulnar/Medial Collateral Ligament Sprains (conservative)
Ulnar/Medial Collateral Ligament Reconstruction
Lateral Collateral Ligament Sprain (conservative)
Lateral Collateral Ligament Reconstruction

Thumb MP

Radial or Ulnar Collateral Ligament Sprain/Strain Injuries
Radial or Ulnar Collateral Ligament Repair/Reconstruction


TFCC Ligament Injury
TFCC Ligament Injury (debridement)
TFCC Ligament Injury (repair)

Nerve Repairs

Nerve Repairs of the Upper Extremity Distal to the Elbow




Rotator Cuff Repairs
Adhesive Capsulitis

Tendon Transfers

Radial Nerve Injuries (early Mobilization)
Radial Nerve Injuries (Immobilization)
Median Nerve Injuries (immobilization)
Low Ulnar Nerve Injuries (early mobilization)
Ulnar Nerve Injuries (Dynamic Transfers)
Rupture of the Extensor Pollicis Longus (EPL - Early Mobilization)
Rupture of the Extensor Pollicis Longus (EPL - Immobilization)
Rupture of the Flexor Pollicis Longus (FPL - Early mobilization)
Rupture of the Flexor Pollicis Longus (FPL - immobilization)


Distal Radioulnar Joint

Ulnar-Shortening Osteotomy
Partial Distal Ulnar Resection (Darrach Procedure)
Partial Distal Ulnar Resection (wafer procedure)
Hemiresection-interposition arthroplasty of the Distal Ulna (Bowers Procedure)
Distal Ulnar Pseudo-arthrosis (Suave-Kapandji Procedure)

Carpal Instability

Dosal Scapholunate Ligament Repair/Reconstruction
Partial Wrist Arthrodesis
Proximal Row Carpectomy
Total Wrist Arthrosis


About the Author

Elizabeth "Ebby" de Herder is currently a practicing occupational therapist and certified hand therapist with over 32 years of clinical experience. She passed the initial certified hand therapy board examination in 1991 and has been practicing her passion in the area of hand and upper extremity therapy since 1985.

Throughout her career, Ebby has established evidence based treatment protocols. She has had the priviledge of working with progressive orthopedic and plastic hand and upper extremity surgeons at university trauma hospitals, local and regional hospitals and private practice physicians in 3 different states. Currently, she is the owner of Charleston Hand Therapy Centre in Charleston, SC and a clinical instructor for occupational therapy students for the Medical University of South Carolina and the University of St. Augustine.

This manual was written to provide all patients, physicians and students with an easy guide using the most up to date evidence based treatment. In addition to offering cited evidence, Ebby added her practical clinical guidance so that the patient has the opportunity to have the best possible outcome.


The AHTA are delighted to be able to offer this resource at a discounted cost courtesy of Exploring Hand Therapy. We are working to maintain and promote high standards of Hand Therapy practice in Australia.

*Please note that postage costs are included for within Australia only. NZ customers, please contact us for pricing enquire@ahta.com.au

Availability: Usually ships in 2-3 days.

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