5 steps to become ot hand therapist

Learn The 5 Steps To Become A Certified Hand Therapist

As an occupational therapist, you know how wide of a variety of jobs and settings we have to choose from. From inpatient rehab, acute care, pediatrics, home health, neuro outpatient, and of course, outpatient hand therapy.

If you’re interested in pursuing a career in hand therapy, you will likely want to consider becoming a Certified Hand Therapist (CHT) once you have met the necessary requirements.

The path to become a Certified Hand Therapist is rigorous and requires additional steps above and beyond just going to OT school and getting a job working as a hand therapist. Becoming a Certified Hand Therapist will not only provide you with more specialized and potentially higher paying hand therapy career opportunities, but it will also provide you with a deep understanding of hand and upper extremity anatomy, biomechanics, and the complex rehabilitation needs of hand injuries or conditions. 

While there are jobs in hand therapy all over the world, I want to note that the requirements in this article are for the United States. Your country may have different standards of becoming certified, so be sure to check with your regulatory boards if you are not based in the US.

That said, here are the 5 steps you’ll need to become a Certified Hand Therapist:

1. Obtain your Master’s or Doctoral Degree in Occupational Therapy

At this time, you cannot be a Certified Occupational Therapy Assistant (COTA) and become a Certified Hand Therapist (CHT) unless you have completed a Master’s or Doctorate OT bridge program.

You can, however, have your Master’s or Doctorate in Physical Therapy and become a CHT, although the majority of CHTs (around 85% as of 2023) are occupational therapists.

2. Have a Current OT State License

The CHT certification requires you to have an active occupational therapy license in the state you are or will be practicing in. You’ll very likely already have this as you start to build experience working in hand therapy, so this one is easy.

3. Take Continuing Education Courses Related to Hand Therapy

Self-studying is important in this expertise. Before you start applying for hand therapy jobs, you’ll want to make sure you’re well-versed on the anatomy and conditions of the hand and upper extremity.

OT school gives you a brief overview of working with hands but does not prepare you enough to go straight to a hand clinic without any relevant fieldwork experience.

how to become hand therapist1

Because of this, it will help immensely to have several continuing education hands courses under your belt before getting your first hand therapy clinic job.

You can find in-person weekend courses near you throughout the year by doing a quick Google search. I also recommend taking online continuing education courses related to hands through platforms like MedBridge.

4. Get a Job in an Outpatient Hand Clinic

According to the Hand Therapy Certification Commission, the certification requires a minimum of three years of clinical experience, including 4,000 hours or more in direct practice working with the upper extremity.

The 4,000 hours of direct practice experience must all be related to the upper extremity. Because of this, it is important to find a job setting that provides hand therapy services to build up those hours of experience. Outpatient therapy settings are your best bets for this.

Many clinics will hire and train you to work as a hand therapist before you have your CHT certification. Just be sure you have taken continuing ed courses related to the hand therapy before moving down this path so you can be prepared.

5. Pass the Hand Therapy Certification Examination

Once you meet the above requirements, you’ll then be eligible to sit for the Hand Therapy Certification Examination (HTCE). I do want to note that this exam is only offered in the spring and the fall, each over a three-week window.

The Hand Therapy Certification Exam is an intense four-hour computer-based test consisting of 200 multiple-choice items. At the time of publishing this article, the exam cost is $500. Please see the HTCE exam cost page for the most up to date information.

htcc logo

The exam covers quite a bit from anatomy and physiology of the hand and upper limb, treatment techniques and tools, to evaluation and therapeutic interventions, among other components.

For a complete list of what the exam covers, be sure to check out this comprehensive exam blueprint from the Hand Therapy Certification Commission for U.S. exam takers.

The CHT exam is not an easy exam, and as such you’ll want to make sure you give yourself plenty of time to study. To put things into perspective, the pass rate in 2022 for first-time test takers averaged 58%, with an average pass rate of 59% over the last 10 years

Even though you’ll have over three years of experience and 4,000+ hours of hand therapy experience prior to being eligible to test, you’ll still really need to prepare for this exam.

Once you hit these 5 steps, you’re officially a Certified Hand Therapist!

Following the passing of the CHT exam, you’re officially a Certified Hand Therapist. Hooray!

As you can see by the requirements, becoming a CHT is not an easy road.

But, if you’re truly passionate about hand therapy as your career choice, the certification is worth pursuing to learn as much as you can and to differentiate yourself as an expert in hands.

In addition, you will open yourself up to more hand therapy positions that only hire therapists that have the CHT certification.


Do you have any other tips or insight for occupational therapists interested in becoming a Certified Hand Therapist?

What questions do you have about becoming a CHT? Please feel free to share your thoughts and questions in the comments below!

Additional Hand Therapy Resources

The OT’s Guide to Hand Therapy Interventions (My OT Spot)

A Day in the Life of an Outpatient Hand Therapist (My OT Spot)

American Society of Hand Therapists About Page

Hand Therapy Certification Commission Home

This post was originally published on December 20, 2016 and last updated on June 27, 2023.

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  • Galit Maresky July 29, 2019   Reply →

    Hi. Good morning.
    I was wondering if you could answer this question for me.
    I am an OT and have been practicing for 24 years now.
    I don’t have a masters degree only a BOT.
    will I need to obtain a masters degree before I can go ahead and work towards the other steps in becoming a CHT?
    Thank you.

    • Sarah Stromsdorfer, OTR/L July 31, 2019   Reply →

      Hi Galit, I looked through the requirements here and it looks like you should be fine with your Bachelor’s in OT as long as you’ve gotten the relevant requirements listed on this page: Hand Therapy Certification Eligibility Requirements If you’re still unsure, I would also reach out to them via their website I linked to just to be sure.

  • John Doe October 13, 2020   Reply →


    I am an aspiring OT with about 12 months left before I am eligible to take the CHT exam. I have a little over 2 years of hand therapy experience. However, due to COVID-19, I was furloughed. It has been 7 months since then and i am sill struggling to find a company that will give me the chance to finish off the last stretch. There is plenty of hand therapy jobs in Arizona. And I have applied to about 20 hand therapy jobs nationwide and interviewed with the few companies that have replied back. However, they will not hire me due to lack of experience and not already being CHT certified. Marketing for hand therapy patients directly to orthopedic surgeons is too risky for them since I am not CHT certified.

    So I am getting to desperation point that I am willing to work for free, non-paid since I am living with my parents rent free. Will direct hand therapy non-paid work experience hours be eligible towards the CHT requirements?

    Thank you

    • Sarah Stromsdorfer, OTR/L October 13, 2020   Reply →

      I’m so sorry you’re going through this right now but I would never advise anyone to work for free (and I don’t think therapy companies can even do this legally!). Since outpatient OT positions do not always require a CHT certification, I would recommend you continue to apply to ones that don’t, and in the meantime work in another setting if you need to. I know acute care hospitals are hiring now so you could even try getting your foot in the door at an acute care hospital that also has an outpatient side, and when the clients pick back up in outpatient you could try to transfer over. Just a thought, but long story short, don’t give up and don’t work for free!

  • David McCombs January 31, 2021   Reply →

    If you’re open to living in Las Vegas there are a lot of hand therapy positions that will take you without having a CHT. I don’t have a CHT and I worked all over Las Vegas as a hand therapist. Just recently the hand center of Nevada asked if I knew of anyone that was looking for a job. I would start there. I will probably never get my CHT because to me it’s not worth it. There are so many businesses desperate for hand therapists. I think right now it’s just bad timing. Best of luck finding a job and feel free to reach out to me if you’re still looking for a job in Vegas. I have some other contacts that might be able to help.

  • Molly May 6, 2021   Reply →

    Hello, I am wondering about a hand therapist’s salary vs an occupational therapist’s salary? I think it looked like a great field to get into, but it IS a lot of studying and time before sitting for the exam. I’m wondering whether it’s worth it? I’ve looked online about this a lot, but I can’t actually find anything that says whether there is a pay increase for hand therapists. Is there? And if so, how much? I’d like to know about both hourly PRN/contract rates and salary rates, and how they compare as a CHT vs an outpatient OT. Thank you!
    Similarly, is the job market better for CHTs than for OTs? I assume the answer is yes if one is an OT trying to work exclusively in ortho, but what about an OT in general who is willing to work in several fields? Is the job market easier for a CHT when compared to the more versatile OT?
    Thank you!

    • Sarah Stromsdorfer, OTR/L May 11, 2021   Reply →

      Hi Molly, great questions! The answers can vary widely based on the job market, location, cost of living, etc. Some CHTs may make more than inpatient OTs, some may make less. It also can vary widely based on the company (is it for-profit or non-profit?), etc. You can start out working in outpatient hand therapy without obtaining your CHT so you can get a feel for if becoming a CHT is the right path for you. Lastly, you can try reaching out to outpatient hand therapists in your area to get their perspectives, which will give you much more insight than trying to search online. Best of luck!

  • Sandy Beyer December 21, 2022   Reply →

    I worked part time in Hand Therapy from 1995-2005 ( I have the hours) I also obtained my Masters degree in May 2022. I currently work in the schools, but would like to go back to Hand therapy and obtain my CHT. I live in Michigan. Could you advise me for the next step to take ? Thank you!!!

    • Sarah Stromsdorfer, OTR/L February 13, 2023   Reply →

      I would definitely reach out to hand clinics in your area to get some up to date shadowing and/or work hours to get a refresher, and then once you start working in hands again you can reach out to the Hand Therapy Certification Commission to find out the next steps to get certified 🙂

  • Nelly-joe Travis April 24, 2023   Reply →

    I’m a currently I’m an OTS and when I’m complete my master I would love to become a hand therapist…how many months will I have to train in that field to become a certified hand therapist

    • Sarah Stromsdorfer, OTR/L April 27, 2023   Reply →

      Once you’re practicing you will need to have a minimum of three years of clinical experience, including 4,000 hours of direct practice in hand therapy before you can sit for the CHT exam.

  • NB February 23, 2024   Reply →

    I live in San Antonio Texas. Do you know of any schools in texas where I can apply.

    • Sarah Stromsdorfer, OTR/L February 27, 2024   Reply →

      You can use AOTA’s accredited OT school search here, just plug in Texas and you’ll find all of the schools there, including any in San Antonio if there are any. Good luck!

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