Katherine can treat a variety of conditions affecting the hand, elbow, shoulder, neck and spine and is covered by most major insurance companies.


Performing arts medicine and preventive measures

Many musicians require a retraining programme that includes instruction in healthy practice habits, stretches, decreasing practice sessions into smaller more regular periods and balancing their playing schedule with other activities, rather than surgical intervention. Musicians where possible are assessed with their instrument, as this provides valuable information to the therapist. A graded return to play program is facilitated as soon as is practical and the musician is guided through rehabilitation with a holistic approach to healing.


Splints can be fabricated out of thermoplastic, neoprene, or plaster of paris. Materials vary in their qualities and are chosen dependant on the requirements of the patient and purpose of the splint.

Bespoke splints can ensure a comfortable immobilisation period and allow skin and wound care to be managed with ease.

Hand Therapists can make splints that:

  • rest inflamed areas
  • protect healing structures
  • increase range of motion
  • prevent or correct deformities
  • facilitate function.

Splints can be classified in relation to their purpose:

1) Static splints have no moving parts and hold the affected area still, and in a functional position

2) Dynamic splints have moving parts such as joints, hinges or springs. Elastic tension using outriggers and finger slings apply forces to replace or counteract the effect of absent or limited muscle power

3) Positional splints hold the limb or joint to prevent deformity or contractures developing

4) Functional splints are designed to improve function or assist an individual with limited movement or muscle power

Exercise therapy and mobilisation techniques

Following injury or surgery to the hand stiffness frequently results. Exercise forms the basis of therapy programmes, and home exercise is encouraged to promote maximum outcomes for the patient. As healing continues and relevant structures can tolerate more exercise the programme is monitored and increased accordingly. Resistance exercises can be included to increase strength in the affected area. If specific joints are stiff then mobilisation techniques can be implemented to assist in regaining the required range of motion. Sometimes utilising hot wax therapy prior to mobilisations can assist in decreasing a patients pain levels and increasing their joint range and functional outcome.

Soft Tissue Massage

Muscular tension may be due to over activity of motor end plates in muscles, and this results in distinct referral patterns of pain. Treatment can include: trigger pointing, soft tissue massage, stretching, icing, acupuncture, home acupressure and activity modification (e.g. how to carry items, and sleeping positions that assist in decreasing symptoms).

Scar management

Scars are formed as part of the normal healing process following injury, surgery or burns. While scars are maturing it is important that the scar is assisted in healing in the most appropriate way. Firm scar massage is necessary to realign collagen fibres that are laid down in a randomised rather than organised manner. Scars can stick to underlying tissues and thus other techniques such as friction to the scar or electrotherapy in the form of ultrasound may be utilised to soften the scar and decrease the sticking process. Silicon gels and pressure garments can also be useful to hydrate and flatten scars. Bespoke pressure garments to assist in treating scaring or lymphodemia are available at London Hand Therapy.

Wound Management

London Hand Therapy Therapists can manage your wound care. Dressings may need to be changed regularly, sutures removed and scar management instigated.

Swelling management

Swelling following surgery or an injury can be part of a natural process, but it can also be part of a disease process. Treatment must focus on decreasing swelling levels so there are no long-term effects on other structures. Compression, elevation, massage and cooling techniques can assist in decreasing swelling levels.

Joint protection and energy conservation techniques

Joint changes can occur due to diseases such as Rheumatoid or Osteoarthritis, or syndromes such as Benign Joint Hypermobility Syndrome (BJHS). Pain, instability and a decrease in functional levels can result. Careful instruction in how to use the hand, upper limb and whole body can prevent or decrease the progression or development of deformities. Ways to decrease the possible damage can be advised, for example spreading the strain to larger joints, or avoiding gripping for long periods of time on narrow or small objects. Energy conservation techniques can also be instructed so that patients have the required energy to perform tasks that they enjoy rather than exhausting themselves with tasks of daily living.  Splinting can also be a very important treatment modality for this patient group.

Work and activity hardening

Functional assessments can provide vital information about how a patient uses their hand, arm and body. Discussion, checklists and observation can enable the therapist an insight into the patient’s life, and in turn assist them in advising about adaptation to task performance, or relevant assistive devices. This advice can be particularly useful for people following complex multiple trauma.


Acupuncture is a useful treatment modality and is based on the principle that there are energetic pathways throughout the body that influence related internal organs and structures. If injury, disease, emotional trauma or infection occurs this natural flow can be affected. Acupuncture enhances the body’s own healing in order to aid recovery and enhance rehabilitation by restoring all the body systems to a state of balance. Extremely fine needles are inserted at selected points, stimulating these areas and assisting in activating natural healing. Dry needling, periosteal pecking; auriculo-acupuncture and electro-acupuncture are available at London Hand Therapy.


Ultrasound is available to treat scars, encourage healing and assist in decreasing pain.

Medico-legal assessment and reporting

Katherine Butler is trained to complete and write medico-legal reports and to attend court. Reports offer expert opinion and reasoning on the effect of work, personal, domestic, travel, and leisure activities including grip and pinch strength, range of motion, endurance levels, cosmesis, function, dexterity, pain, and sensation. Claimant, defence and joint witness work is undertaken, and legally aided clients are welcomed. She has mainly performed this training with the highly reputed Bond Salon Medico-legal training firm, and has written a wide variety of reports on varying hand and upper limb conditions.


  • Work related upper limb disorder
  • Musicians injuries and preventative measures
  • Fractures
  • Dislocations
  • Dupuytren’s disease
  • Carpal Tunnel Syndrome
  • Tendon Injuries and transfers
  • Osteoarthritis
  • Rheumatoid Arthritis
  • Ligament injuries
  • Ganglions
  • Soft tissue injuries
  • Scarring
  • Paediatric injuries and conditions
  • Scar hypersensitivity
  • Tendonopathies
  • Wrist pain
  • Burns
  • Benign Joint Hypermobility Syndrome (BJHS)
  • Crush injuries
  • Swelling
  • Complex regional pain syndrome
  • Trigger finger
  • Nerve injuries
  • Congenital hand anomalies
  • Shoulder impingement
  • Sports Injuries
  • Joint Replacements and Fusions

London Hand Therapy:

  • Injury prevention
  • Hand and upper limb assessment and treatment
  • Postoperative management

Hand Therapy is both an art and a rehabilitation science for the upper extremity. The injured limb is evaluated and assessed, and a variety of treatment methods are used to achieve set therapeutic goals.

Hand therapists are qualified Occupational Therapists and Physiotherapists who have become skilled in treating upper limb injuries and deformities through further education, training and clinical experience.