FAQs

Casts and Splints

  • What's the purpose of a cast or splint?

    Splints and casts support and protect injured bones and soft tissue, reducing pain, swelling and muscle spasms. In some cases, they are applied after surgery. They can be custom-made of plaster or fiberglass if an exact fit is needed. In other cases, ready-made off-the-shelf splints are preferred. Available in a variety of shapes and sizes, they come with Velcro straps that make them easier to adjust and use. After initial swelling has subsided, proper splint or cast support will usually allow you to continue your daily activities with a minimum of inconvenience. 

  • How does a doctor determine whether to apply a splint or a cast? 

    In many cases, a splint is applied to a fresh injury and, as swelling subsides, a full cast may be used to replace it. Sometimes it is necessary to replace a cast as swelling decreases and the cast "gets too big." Often as a fracture heals, a splint may be applied again to allow easy removal for therapy. 

  • What if I experience swelling while wearing a splint or cast?

    Your injury or surgery may produce swelling, which can create pressure and cause your splint or cast to feel too snug. To reduce the swelling, elevate your injured arm above your heart by propping it up on pillows or some other support. Elevation allows clear fluid and blood to drain "downhill" to your heart.

    During the first 24 hours after your injury or surgery, you may apply ice to the splint or cast. Place the ice in a dry plastic bag or ice pack and loosely wrap it around the splint or cast at the level of the injury.

  • Are there warning signs I should look for that might require changing my splint or cast?

    If you experience any of the fullowing warning signs, contact Dr. Brown's office immediately:

    • Increased pain, which may be caused by swelling, and the feeling that the splint or cast is too tight
    • Numbness and tingling in your hand or foot, which may be caused by too much pressure on the nerves
    • Burning and stinging, which may be caused by too much pressure on the skin
    • Excessive swelling below the cast, which may be a sign that the cast is slowing your blood circulation
    • Loss of active movement of your fingers
  • How do I care for my splint or cast?

    It is important to keep it in good condition. This will help your recovery. To do so:

    • Keep your splint or cast dry. The padding beneath the cast surface is not water repellent. Keeping your cast as dry as possible helps to prevent skin irritation and odor. The inside of the cast should be dried with a hair drier (set on a cool setting) in the morning, evening, and after bathing or exercise, as frequently as necessary. This will help prevent itching and reduce skin irritation.
    • Bath with your splint or cast in a plastic bag or plastic wrap. Huld your hand up in the shower so that water does not run down inside the splint or cast. If your cast get wets, blot it with a towel and then use a blow dryer (set on a cool setting) to dry it completely. If this does not work, contact Dr. Brown's office.
    • Do not trim or re-shape your splint or cast. Your splint or cast has been custom-designed to provide maximum support during healing. Cutting or altering it may lengthen your recovery time. If the padding has shifted and the edge of the splint or cast rubs against your skin, you may be able to pad it with muleskin (available in the foot care section of any drugstore). If it feels too tight or is irritating your skin, please contact Dr. Brown's office. It may need to be modified or changed. But we would rather do that than see you have a problem.
    • Resist the urge to scratch. Almost every splint or cast itches at some time. But never insert anything under it to scratch an itch. You could cause severe skin injury. Avoid getting dirt or other foreign particles under your splint or cast as well. Neither talcum powder nor corn starch should be applied inside it, as they may cause a skin infection.
    • Inspect the skin around the cast. If your skin becomes red or raw around the splint or cast, contact Dr. Brown's office.
  • Can I remove my cast myself?

    Never remove a custom-made splint or cast yourself. You may cut your skin or prevent proper healing of your injury. Dr. Brown's staff uses special bandage scissors to remove splints and a cast saw to remove casts. Cast saws make noise and may feel "hot" from friction, but will not harm you; their "bark is worse than their bite." 

Cortizone Injections

  • What does a cortizone injection do?

    Cortisone is a synthetic steroid that can greatly reduce inflammation, swelling and pain. A local injection with cortisone is less complicated than surgery and often provides lasting pain relief. Sometimes it takes more than one cortisone injection to be effective.

  • Aren't steroids dangerous?

    Cortisone is unlike the steroids that some athletes take to increase their muscle size or to gain weight because it is injected locally; very little of it goes beyond that region.

    Complications from steroid injections are uncommon. Still, like all medications, cortisone poses certain risks and possible complications. If you have diabetes, steroid injections may cause a temporary increase in your blood sugar levels. Cortisone injections may cause changes in skin pigmentation and thinning of the skin. Tendon rupture, nerve injury, allergic reactions and infections are also very rare complications following cortisone injections. If you have symptoms of an allergic reaction or infection following such an injection, contact Dr. Brown's office immediately to arrange for treatment. Symptoms of an allergic reaction can include trouble breathing, wheezing, tightness in your chest, swelling on your face, skin rash or itching. Symptoms of an infection include severe swelling, pain, redness or fever. If you experience any of these symptoms, contact Dr. Brown’s office immediately for treatment.

    It is not uncommon to have increased pain in the area for a few days following a cortisone injection and it may take a few weeks for you to feel the full effect of the injection.

Desensitization

  • Why are my hands so sensitive since my injury?

    The nerves in the hand are special and are more sensitive than other parts of the body. Hand injuries are often very tender during the early healing phase. Often, tenderness in scars gets worse beginning one to two weeks after injury or surgery. After any injury, the skin of the hand must get used to being touched again for the tenderness to go away. If you do not touch the sore areas of your hand, they may remain very sensitive and tender.

  • What therapies can help my hands feel less sensitive and tender?

    Percussion and Friction Massage can both help speed the process of recovery from tenderness in your hands and fingers. Check with Dr. Brown before beginning these exercises to ensure your hand is sufficiently healed to complete them safely.

    The goal of these exercises is to make your wounds less tender. It is normal for these exercises to feel somewhat uncomfortable while they are being performed and shortly afterwards. If the exercises are too painful, try using less pressure. If pain remains, give yourself a several hour break and try again. If pain continues to be a problem, contact Dr. Brown or your physical therapist.

    PERCUSSION (Tapping)

    This technique activates the automatic reflex which typically makes us ignore things that are very repetitive. This reflex will dull the tenderness in areas of your hand that are touched repeatedly. To do percussion:

    1. Tap lightly on the area of your hand that is tender using a finger tip on your opposing hand or with a light object such as a pencil.
    2. Find the spot that is most tender.
    3. Note the time, and begin to tap rapidly (2-3 times a second), lightly and continuously on the most tender area.
    4. Keep tapping without a break for three minutes or until you notice the feeling in the area change. The area may start to feel numb or it may simply feel slightly less tender.
    5. Take a one-minute rest and begin again. You may find that a different area is now the most tender spot on your hand.
    6. This exercise should be done as many times as possible during the day. It takes many thousands of taps to truly change the tenderness in a sore area. The sooner you accumulate that many taps, the sooner your wounds will be more comfortable.

    FRICTION MASSAGE

    The goal of friction massage is to stretch the scar tissue beneath the skin. As with percussion, it should be performed many times throughout the day. This exercise not only helps improve tenderness, but helps restore the contour of the skin to a more normal appearance. To do friction massage:

    1. Place a finger tip of your opposing hand against the central area of your scar.
    2. Mentally note four directions that the skin can be pushed sideways: near, far, left and right.
    3. With your finger tip pressed firmly against the scar and without sliding, gently but steadily push the skin to one side as if you were trying to slide the skin off of the bone. Huld this position for five seconds.
    4. Briefly relax and then repeat this maneuver in one of the other directions. Make sure you attempt to slide the skin in all four directions.
    5. If the scar is wider than your finger tip, repeat this stretching exercise on every point of the scar.
    6. This exercise should be performed without any skin lubrication. Remember to do it before applying any antibiotic ointment or moisturizing creams.

LIVING WITH ONE HAND

  • Help! How do I live with one hand?

    It's tricky, but not impossible to get on with your life even when one hand is not working. 

    The fullowing may be helpful, whether you are recovering from a hand problem or anticipating surgery on your hand. Although some of these points are an issue only if your writing hand is affected, most apply to problems invulving either hand. Most situations can be managed without the need for special adaptive devices.

    Ask for help. Enlist others ahead of time to help with child care, housework and meals.

    Practice doing things with one hand. If you know you will be laid up, practice the fullowing things prior to your surgery:

    • Dressing
    • Undressing
    • Using the toilet
    • Brushing your teeth
    • Showering

    Plan ahead for the first few days after surgery:

    • Open and re-seal cans and bottles you might need.
    • Open medication containers and leave then easy to reopen. Put these medication containers out of the reach of children, even if you don't expect children to visit.
    • Plan ‘no-cut’ meals — sandwiches, ground meats, etc.

    Stock up on items that will make your life easier.

     In the shower

    • Use plastic bags and rubber bands to cover bandages or splints; the bags that newspapers come in are good to cover the hand and wrist. Small trash can liners also work. Use two at a time.
    • Use a bottle sponge (soft sponge on a long stick) for the armpit of your "good" hand.
    • Use a shower brush.
    • A hair brush in the shower will help you to wash your hair.
    • A cotton terry cloth bathrobe will help to dry your back.

    In the bathroom

    • Use toothpaste, shampoo, etc. in flip-top or pump (not screw top) dispensers.
    • Consider an electric razor.
    • Use flossers (dental floss on a "Y" shaped handle).

    In the kitchen

    • Choose a Dycem mat (rubber jar opener mat) to help open jars. It will also keep things from sliding around while you are working on them.
    • Use an electric can opener with a lid magnet that is strong enough to hold the can in the air for one-handed use.

    In the bedroom

    • Try a back scratcher.
    • Dress in large sleeve shirts and tops.
    • Avoid clothing that buttons, fastens or snaps in the back or that uses drawstrings.
    • Choose a sports bra or a camisole instead of a regular bra.
    • L'eggs Sheer Energy nylons can be pulled on one-handed — most others can't.
    • Choose a "wash and wear" haircut.
  • Where can I get more information about living with one hand?

    A wonderful resource is the book, One-Handed in a Two-Handed World (ISBN #09652 80500). This book is filled with practical tips and tricks, and it was written by someone who became one handed — and dealt with it. From tying your shoes to doing household repairs one-handed — it's all there. 

STEEL PINS

  • Do I need to worry about the steel pins protruding through my skin?

    No. The pins are made of stainless steel and can, in some cases, stay in for a number of weeks. Your job is to simply keep them clean and protect them from catching on sheets or clothing. Eventually, they will be removed on a visit to Dr. Brown's office. In some cases, however, they may need to be removed in an operating room.

  • How do I care for steel pins?

    The pin site (where the pin enters the skin) may be covered with dry gauze or left open to air. To care for the pins:

    • Clean the pin and the point where it enters the skin with hydrogen peroxide and a Q-tip at least three times a day.
    • If the pin site gets wet from washing, simply clean the pin and the point where it enters the skin with hydrogen peroxide and a Q-tip.

    Pins may appear to be loose or turn in place. This is usually not a problem, as long as they are left alone. Occasionally, a pin will catch on something and pull partly or all the way out. This most often occurs after the pin has been in for several weeks. Although this does not usually create a problem with the outcome of surgery, contact Dr. Brown's office for further instructions. Please do not push the pin back in.

    It is normal for a small amount of redness to form around the pin site the longer they are kept in and for clear yellow or orange fluid to drain occasionally from the pin sites. If the pin sites drain pus or become increasingly red and painful, contact Dr. Brown's office.