Upper Extremity Cast Care
Patient instructions:
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Elevate the arm with your elbow above the heart, fingers pointing towards the ceiling. This is easiest when lying down on a bed or couch.
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Your child should wear the sling when they are not in bed, as instructed by the care team.
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If your child is complaining of pain, give pain medicine as directed by your healthcare provider. Propping the arm as described above is helpful to relieve pain.
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Check to be sure the fingers are not swollen, blue or gray. If they are, call your healthcare provider, or go to the emergency room. Your child should be able to move or wiggle all their fingers. They should be pink and warm once the cast is dry.
General cast care
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Keep the cast clean and dry.
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Your child should not put anything down inside the cast, including their fingers. It may cause a sore or infection. Pushing things into the cast may bunch up the cast padding and irritate the skin. This may also push the padding away from the skin and put your child at risk for a cut or burn when we remove the cast.
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Your child should not pull the padding out the cast. The padding protects the skin from rubbing and sores.
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If your child gets the cast wet, puts anything down the cast or pulls the padding out, please call 215-590-1527 so it can be changed or repaired.
Skin care
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Do not use lotions, oils or powder on the skin under the cast.
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If your child complains of itching: use a blow dryer set on cool to blow air down the cast. You can also knock gently on the cast to relieve itching.
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Do not use items such as a “Cast Blaster,” which blows air into a cast with a thin straw. The thin straw can scratch the skin or even cause serious burns of the skin.
Clothing
No special clothes are needed. Clothes should be loose and comfortable.
Bathing and hair washing
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Your child may need to have sponge baths until the cast is removed. This is important for children under the age of 3 who tend to splash.
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For older children, there are cast covers that you can purchase online or at a medical supply store. If you choose to use a cast cover, you must make sure that it does not leak, and the cast does not get wet.
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Cast covers are only for use in the shower. And avoid submerging your cast under water, even with the cast cover in place.
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Washing your child’s hair:
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You may lay a small child down with their head in the sink and wash their hair.
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You may lay a child across a bed and place a bucket on the floor to catch the water as you shampoo.
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Liquid no-rinse shampoos are available as well.
Safety
Returning to school or daycare
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Your healthcare provider will tell you when your child can return to school. Generally, your child should be off narcotic medicine during the day before returning to school.
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Your child will be given a school note stating activity limits, which may include no gym or recess.
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Your child should not ride a bike, roller skate, climb on a jungle gym or other such activities while in an arm cast.
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If your child cannot go back to school, talk to the school nurse about home tutoring.
Call you CHOP healthcare team with questions, concerns or if:
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Your child has severe pain, and the pain medicine does not help
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You see a change in the cast: cracking, softening, drainage from the inside.
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You smell a bad odor coming from the cast
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Your child’s fingers are cold, blue, gray or swollen.
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Your child feels numbness or tingling in the fingers.
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Your child cannot move their fingers.
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There is a change in the position of the fingers in the cast or the cast looks like it is slipping off.
Weekdays:
215-590-1527 if your cast was placed in our Philadelphia, Princeton or Voorhees sites.
If your cast was placed in our King of Prussia office, call 215-590-6919.
Nights, weekends, and holidays:
Call 215-590-1000 and ask the operator to page the orthopedic resident on call.
Reviewed March 2024 by Meg Morro RN, Kate Easby ATC