Casting and Splinting
Your local Northern Beaches expert in hand and arm casting and splinting to assist with your recovery.
Casting and splinting on the Northern beaches
After breaking a bone in the arm, wrist, or hand, you will typically need to have the bone and nearby areas immobilised in a cast or splint so that the bone can heal in the correct position, minimising the chances of ongoing pain, deformity to the bone, and optimising use of the arm after it heals. This is also the case after some ligament and tendon injuries in the arm to help bring down pain and let irritation settle before returning to activity.
Hospital emergency and outpatient departments are usually the first port of call for getting either a plaster (of Paris; soft) cast for a fresh break, or a fibreglass (coloured; hard) cast after the initial 7-to-10 days, however there are often long wait periods in hospitals and they’re not the nicest place to spend half a day. Similarly, waiting 3-to-4 hours for a thermoplastic splint to be made can eat up a fair chunk of your day.
Our practitioner in Hand Therapy, Mace, can apply plaster of paris and fibreglass casts in-clinic for all variety of upper limb injury as needed, as well as fabricate custom thermoplastic splints for some bony injuries, ligament injuries, and tendon and nerve conditions. With some notice to get the necessary equipment, Mace can also fabricate dynamic and progressive splinting with outriggers for more complex injuries including flexor and extensor tendon repairs of the fingers.
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Do I need a cast or a splint?
Casts are applied in the clinic nearly-always for broken bones, with the size, shape, and length dependent on the type and severity of the broken bone. If you have had surgery and your post-operative cast has come off or broken, a replacement cast can be created or, depending on the surgery, a thermoplastic splint can be fabricated to mimic the effect of the cast.
Casts
If you are coming directly from the GP or imaging facility with a fresh break, you will typically need a plaster of Paris cast (also known as a “backslab”) that goes on one half of the arm and held on with soft underlay and crepe bandage so that swelling can develop and not cause issues with circulation while still supporting the broken bone to heal. These casts unfortunately are not waterproof and need to stay dry for the time they are worn – but thankfully they are usually only required for 7-to-10 days after the injury until swelling settles down.
Waterproof Casts
After the backslab period, or if it has been a few weeks since the injury and it was picked up late but there is no swelling, you will have a fibreglass cast made with a water-resistance underlay that can get wet in the shower. These casts are the coloured casts you see in public and go all the way around the arm. They provide the best support for a broken bone to set for the remaining 4-to-5 weeks.
splints
In some cases, a cast can be too large or annoying to put on so a splint is made instead. These splints are measured, cut, and moulded to the arm and are removable with Velcro however in the case of broken bones, are recommended to be worn 24/7 to make sure the bone heals well and in the right position.
how do splints work? Do I need one?
Splints are useful for a number of non-bony injuries, and while there are some splints you can get over the counter at the pharmacy, they can be ill fitting or not quite right, so one that is made moulded to your arm can be a literal and figurative better fit. Some conditions that benefit from splinting include:
- Capsular contracture of the elbow (a really stiff elbow that won’t straighten)
- TFCC injuries (ligament complex injury to the pinky-side of the wrist)
- ECU tenosynovitis (pain with lifting and tilting the wrist to the pinky side)
- Scapholunate and Lunatotriquetral ligament injuries (wrist instability and pain with gripping)
- Carpal Tunnel Syndrome (tingling in the thumb, pointer, and middle finger)
- Guyon Canal Syndrome (tingling in the ring and pinky fingers starting at the wrist)
- Wartenberg Syndrome (pain and numbness along the thumb-side of the forearm and hand)
- DeQuervain’s Tenosynovitis (pain with wrist flicking movements)
- Intersection Syndrome
- Trapeziometacarpal and STT-Joint Osteoarthritis (painful base of thumb arthritis)
- Fractures to the carpals, metacarpals, and phalanges (various hand and finger bones)
- Mallet and Jersey Finger / Thumb
- Pulley injuries (typical in league tag and flag football, and in rock climbers)
- Dupuyten’s Contracture
- Swan Neck and Boutonnière Deformities
More complex conditions like flexor and extensor tendon repairs require a more complex style of splint and can be fabricated in-clinic, however a couple days’ advance notice is required to source appropriate materials and develop the best splint shape option before the appointment
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How long is a casting or splinting session?
Fabricating a cast or splint should take no longer than 45 minutes from start-to-finish, with the first follow-up session to remove the cast / splint, assess healing and important metrics on healing, and start the rehab process also being 45 minutes (only for the first follow-up) than 30 minutes thereafter.
It is important to note that unfortunately health insurance providers do not cover the cost of casting and splinting materials, just consult costs. The extra cost of a cast or splint is dependent on the amount of materials used, however varies from $15-20 for a finger splint, to $70-100 for a plaster of Paris cast and $80-100 for a fibreglass cast (more for casts that need to extend beyond the elbow), and from $50-140 for basic thermoplastic splints (more for dynamic splints and more complex designs)
FREQUENTLY ASKED QUESTIONS
Yes!
Female Pelvic Health Physiotherapy is what people traditionally thing of when they think of below-the-belt issues – ranging from pregnancy-related pain in the back and pelvis, prenatal physiotherapy to assist with changes in body size, pelvic dynamics, and bladder and bowel changes, and post-pregnancy rehabilitation to restore normal bladder and bowel function, reduce puerperal (post-delivery) pain and sensations of weakness or “instability” around the pelvis, and return to day-to-day life including work, gym, and sport.
Outside of pregnancy-related conditions, Pelvic Health Physiotherapy addresses both painful and frustrating conditions that can affect day-to-day life and bedroom endeavours, including:
- Endometriosis and PCOS
- Urinary Frequency and Urgency
- Proctalgia Fugax
- Pudendal Neuralgia
- Pelvic Myalgia
- Vaginismus and Penetrative Dyspareunia
- Vulvodynia, Vestibulodynia, Vaginodynia, and Culpodynia
- Pelvic Mesh and Fibroid Removal Rehabilitation
- Persistent Genital Arousal Disorder
Some of these conditions require external (and in some cases, internal) examination of the pelvic region during the initial assessment to adequately determine how to proceed and treat, so it is recommended to bring a support person or partner for the initial session to help with comfort and so that everyone involved understands what the rehabilitation may entail.
Yes!
To assist with minimising gender dysphoria, physiotherapy is involved in the care of transgender people both before and after gender-affirming surgeries, as well as those who identify as transgender but don’t elect for surgeries. Transgender-affirming services offered include:
- Chest binding best practice and pain minimisation
- Tucking best practice and pain minimisation
- Chest feminisation surgery rehabilitation
- Chest masculinisation surgery rehabilitation
- Neovaginoplasty rehabilitation and dilatation
- Phalloplasty (particularly Radial Free-Flap Phalloplasty) rehabilitation
This is in addition to the gender assigned at birth conditions mentioned in the male and female sections above that may occur. Because some of these transgender-specific and other pelvic health conditions can be dysphoric, it is recommended to have a support person through the sessions for comfort, as well as bring any support or structured garments you regularly use.
Pelvic Health Physio sessions are 60 minutes typically for the initial session, and then depending on the complexity of the case, follow-ups can be 30 or 45 minutes, however Mace will discuss in the initial session what the follow-ups will entail and how long they’ll take
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