The Hand Therapy Certification Commission (HTCC) was founded through the American Society of Hand Therapists (ASHT). ASHT was incorporated in 1977 to advance the specialty of hand therapy through communication, education, research, and the establishment of clinical standards. At that time, membership in ASHT was restricted. Therapists completed an extensive application and portfolio to be considered for membership. ASHT membership became a de facto form of certification recognizing members as being hand therapy experts. By the mid-1980’s, antitrust laws against organizations with strict membership qualifications were being enforced. It was felt that restricting membership was a form of discrimination and that membership in an organization should be open to a broad range of individuals in a professional field. This led ASHT to investigate avenues to recognize clinical experts while also encouraging membership of therapists at all stages of their professional development in hand therapy. ASHT’s Certification Committee followed national guidelines developed to assist similar organizations in establishing objective certification programs. The first step in the process was to perform a role delineation study (practice analysis) of hand therapy. ASHT members and non-members who practiced hand rehabilitation were surveyed. The results formed the basis for the first definition and scope of practice of hand therapy and were used to determine the test blueprint for the initial certification examination. This study was published in the inaugural issue of the Journal of Hand Therapy in 1987. ASHT membership voted to proceed with a formal certification program at the 1987 ASHT annual meeting. HTCC incorporated as a separate entity from ASHT in 1989 to legally ensure an unbiased certification program. Since then, ASHT and HTCC have maintained a close relationship to promote the missions of both organizations; however, they are administratively independent and do not have influence over the other’s policies, procedures, or activities. The inaugural Hand Therapy Certification Examination (HTCE) was administered in May 1991 in the United States and Canada. It marked the designation of the first group of Certified Hand Therapists (CHTs). Since then HTCC has performed practice analysis studies every five to seven years to ensure the scope of practice and HTCE blueprint reflect current practice standards. Today, the HTCE examination is delivered worldwide and CHTs practice in more than twenty countries.