1. Plaster cast care
Keep your arm or leg raised on a pillow for the first 12 hours and rest. This will help any swelling to go down. Continue to do this for another 12 hours if the cast still feels tight.
Don't get your plaster cast wet. This will weaken it and your bone will no longer be properly supported.
You can use a plastic bag to cover up the cast when you have a bath or shower. Try using sticky tape or a rubber band to seal the bag at the top and bottom, to make it as watertight as possible. Alternatively, it is possible to buy special covers for plaster casts to keep them dry. Ask your local pharmacist (chemist) for more information.
Always remove the bag as soon as you can, to avoid causing sweating, which could also damage the cast.
Even if the plaster cast makes your skin feel very itchy, don't be tempted to poke anything underneath it. This could cause a nasty sore. The itchiness should settle down after a few days.
More plaster cast tips
- Don't let any small objects fall inside your cast, as they could irritate your skin.
- Don't try to alter the length or position of your cast.
- Don't lift anything heavy or drive until the cast has been removed.
- Use crutches or a sling, as advised by your health professional.
Plaster cast problems
You should go to A&E (accident and emergency) if:
- plaster cast still feels too tight after keeping it elevated for 24 hours,
- fingers feel swollen, tingly, painful (even after taking painkillers) or numb,
- fingers turn blue or white,
- cast feels too loose,
- cast is broken or cracked,
- the skin underneath or around the edge of your cast feels sore, or
- there is an unpleasant smell or discharge coming from your cast. If you have any concerns about your plaster cast, you can call a doctor for advice.Source: http://www.nhs.uk/chq/Pages/2543.aspx?CategoryID=72&SubCategoryID=721
- fingers feel swollen, tingly, painful (even after taking painkillers) or numb,
- fingers turn blue or white,
- cast feels too loose,
- cast is broken or cracked,
- the skin underneath or around the edge of your cast feels sore, or
- there is an unpleasant smell or discharge coming from your cast. If you have any concerns about your plaster cast, you can call a doctor for advice.Source: http://www.nhs.uk/chq/Pages/2543.aspx?CategoryID=72&SubCategoryID=721
I would add the following reasons to contact a doctor:
- if the swelling appears after the plaster cast put in wrist operation is changed
- if the elevated position of the hand is the only comfortable position (after the first days)
- if you start to feel pulling or cramp in your finger(s)
- if your fingers start to bend and stay crooked
- if you start to feel pulling or cramp in your finger(s)
- if your fingers start to bend and stay crooked
In case of a wrist operation, the fingers are usually not swollen, because there is gauze under the plaster cast. When this cast is taken away and changed to a new plaster cast or wrist support, you get under it a tubular bandage. If the swelling appears after the change of the cast or support, the tubular bandage is too tight.
2. Exercises for a hand in plaster cast or wrist support
You can start the exercises as soon as the cast is dry.
Repeat every exercise 10 times and 3 - 5 times per day.
Cast on the hand can complicate gripping, reaching, dressing, writing and eating.
Try to use your hand as much as you can in normal activities, but avoid lifting heavy objects during the first 100 days after a fracture or bone operation.
In some cases you get, for the last weeks, a wrist support instead a plaster cast.
Exercise for the thumb
Bend the thumb slowly towards the little finger (pinkie) base, and then extend the thumb to the side. Repeat 10 times.
Touch with the thumb the tip of the finger, bending the finger at the same time, then extend the finger straight.
Repeat 10 times with each finger.
Bend and extend the fingers
Repeat the exercise a few times.
Extend the fingers wide apart
Extend the fingers straight and then wide apart, as much as possible and stretch during 10 seconds, then bring the fingers back together. Repeat the stretch a few times.
Shoulder
a. Lift your arm up so that your overarm touches your ear
b. Stand with your back against a wall. Lift your arm sideways up, straight. Let your arm glide downstairs touching the wall.
c. Lift your arms up and bring them behind your neck, so that the fingers touch. Then, move your elbows backwards.
d. Bring you hand in plaster cast behind your back and try to touch the shoulder blade on the other side of your back.
Elbow
Bend the elbow, extend the elbow ( if not in plaster cast)
Swelling in plaster cast or wrist support
In case the hand is swollen, keep your hand as much as possible in vertical or elevated position. Repeat the exercise "Bend and extend the fingers" and try to pump away the swelling. This exercise doesn't always help.
If the tubular bandage is unpleasant and you have a feeling that it is too tight, change the bandage, if possible. Sometimes hospitals have only on size of bandage, but they are sold in pharmacies.
3. Mobilization exercises for hand and fingers after plaster cast or wrist support
After a plaster cast, wrist, hand or fingers need workout, you will get the instructions from a physiotherapist specialized in hand rehabilitation. Physiotherapist in hospitals gave these instructions.
Hand and finger exercises are to do every day, a good rule is every two hours. Make the gymnastics very slowly, take the movement as far as possible and keep the end position for some time, and stretch.
In addition of the gym, use and move your hand as diverse ways as possible, but avoid lifting heavy objects during the first 100 days after a fracture or bone operation.Thumb flexion
Slowly bend your thumb toward the little finger base and hold for 5 to 10 seconds. Assist if necessary. Then extend your thumb to the side. Repeat 5 - 10 times.
Slowly, touch with the thumb the tip of each finger, and extend the finger after the touch. Repeat five times per finger. This exercise was given when my hand was still in the plaster cast.
Exercise catching of small objects with the fingers.DIP joint flexion.
If you do not have the plastic disc, bend the DIP joint of a single finger and at the same time keep the PIP joint straight with the other hand. Keep the fingertip bent from 5 to 10 seconds and then extend the finger straight. Repeat 5 - 10 times for each finger. I got the
PIP joint flexion
Make the same movement, each finger separately, but bend the PIP joint and hold the flexion of 5 to 10 sec period. Extend your finger straight. Repeat 5 - 10 times for each finger.
Bending one finger at a time
Keep your fingers straight and slowly bend one finger toward the palm. The movement is easier to do, if you keep your other fingers in place with the help of the other hand. Keep the bend from 5 to 10 seconds and then extend your fingers straight. Repeat 3 to 5 times for each finger.
Note: If you fingers are bent, even slightly, after repeated bending they will be more bent. The counter movement is straightening stretch against a firm surface; the use of ring splints will help also.
Knuckles flexion
Bend the knuckles at right angle, keep the fingers straight, and hold for 5 to 10 seconds. Extend your fingers straight and hold for 5 - 10 seconds. Repeat 5 - 10 times.
Palm rolling with a ball
Put the hand on top of an appropriately sized ball and roll the ball with the palm, from the bottom of the palm up to the fingertips. Repeat 30 times.
Squeeze of a sponge or a ball
A strong squeeze is an excellent way to increase strength in hand and fingers and to eliminate tension.
Keep the wrist behind and squeeze the ball in slowly for 10 seconds, repeat 10 times.
You may start with a sponge.
When you move to a ball, you need to find the right size and right flexibility, not too soft. I found this ball in a toy store and it's diameter is about 6,5 cm (2.53 inch). By squeezing it, I can flatten it out to a disc, which height is under 3 cm (about 1 inch).
When the hand and fingers become stronger, you need to change the ball to a firmer one.
The counter movements of squeeze are the straightening stretch against a table; and the stretch for cramp removal; make them, if necessary.
Squeeze of grains
Put your hand inside a cotton pouch filled with 2 kg of grains (wheat), and squeeze the grains with your hand. Ask a physiotherapist for further instructions.
You can also warm can the pouch in micro-oven for 4 to 5 minutes, before you do this exercise. See section 6. Hand warming. The temperature is maintained for a long time in grains.
Stretching exercises for hand and fingers
Stretch wide apart
Spread the fingers apart widely, stretch during 10 seconds, and then bring them back together. Repeat the stretch a few times.
Some time ago, and from time to time, the PIP-joint in my little finger in the right hand began to bend like a "gear". It was hurt in School, during a volley match, when I was 15 years old. When this happens, I do a stretch wide apart and it helps, at least for a while.
Hand cramp removal
After the both surgeries, when the plaster cast was removed, I felt cramps in the hand and the fingers; and the fingers bended spontaneously. If you make precision
handwork for long periods without resting the hands, they can also cramp. For this reason, in some craft books there are stretching instructions for cramp removal.
For removal, stretch the palm and fingers using your other hand. You can also push the fingers against the surface of a table and stretch. Do also other hand stretches and massage the hand. This stretch is an excellent counter movement after the bend/extend stretch or after squeezing a foam disc.
4. Wrist stretching and mobilization after plaster cast
After a plaster cast, the wrist may be stiff and needs stretching.
Exercise and swimming in warm water is the best way to rehabilitate a stiff wrist and hand; it improves the movements and flexibility.
If this isn't possible, you can do the following exercises:
Wrist rotation
Place your forearm on a table palm down, then turn the palm up and hold for 10 seconds Repeat from 3 to 5 times.
You can also do a stretch in such a way that you put your elbow to your side and slowly rotate your forearm so that palm looks alternately up and down, and hold the position for 10 seconds.Wrist Stretch
Pull the hand against a low table and then turn the arm to more upright position so that the stretch can be felt inside of the wrist; keep the stretch for 10 seconds. Repeat three times.
Wrist stretch backwards and forwards without a weight
Place your the forearm on a table so, that the palm is outside the table edge and facing downwards. Bend your fingers in a fist and lift your wrist up (back) and hold for10 seconds. Extend your fingers and bend your wrist downward (forward) and hold for 10 seconds
Wrist stretch backwards and forwards with a weight
To boost the wrist lift upwards and downwards do the exercise with a small weight, at most up to six pounds (500 g). The physiotherapist recommended this movement one month after the finger surgery. Check with a specialist physiotherapist, when you can start training with weights.
Stretch the wrists from side to side with interlaced fingers
Put your elbows on the table, raise your hands and interlace your fingers.
a) Bend your wrists gently from side to side and front - back.
b) Turn the hands so that you see the back of your right and left hand alternately.
Repeat both exercises from 5 to 10 times.
Stretch the wrists with interlaced fingers
Interlace the fingers so that the palms are towards yourself and then turn the hands slowly to opposite direction. Repeat a few times.
The physiotherapist in Djerba / Tunisia asked me to do this exercise, and I wasn't able to do it the first day, but the next day I was.
5. Water gymnastic and swimming
Exercise and swimming in warm water is a very good way to rehabilitate a stiff wrist; it improves the flexibility.
In Helsinki, there is a hydrotherapy pool in Mäkelänrinne, where the water is slightly warmer than in the normal pool.
This blue water gym equipment, stretching gently the palm, was in use in Djerba /Tunisia, as well as the yellow foam disc. The Spa had a warm seawater pool at 30 ° C, and the possibility for individual rehabilitation.
My program included mainly two types of movements:
- I walked in the pool, bringing the knees up sharply, and at the same time I did twisting and turning movements with the wrists and hands, using a light tool to increase the resistance.
- I moved forward along the railing of the pool with the help of my hands, turning the wrist up and down alternately, in this exercise I did not touch the bottom of the pool with my feet.
The physiotherapist made the same movements and corrected immediately, if I didn’t do the movement properly.
With the help of water gymnastic, the flexibility of my wrist increased much more in one week than with mobilization exercises during the three preceding months.
6. Hand warming
Hand warming increases the mobility of the hand and fingers, remove the tension and increase the sense of flexibility in hands.
Warming can be made with 2 kg of grains (wheat), in a cotton pouch, which is heated in micro-oven for 4 to 5 minutes. Put the hand in the pouch, do different movements and squeeze the grains. Ask a physiotherapist for further instructions. The temperature is maintained for a long time in grains.
Warm water increases the flexibility in the hand, and a warm shower directed to the hand activates the blood circulation.
You get good exercise for the hand and fingers when you wash clothes by hand, in warm water. In case you need to increase the flexibility of your wrist, water gymnastic is much more efficient.
Keep the hands warm in draughty and air-conditioned areas by using gloves or fingerless gloves. Hands stay warm at night with woolen fingerless gloves; they also reduce the stiffness in the hands in the morning. Choose a model, which is not too tight.
7. Skin care & massage of the scar
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Rotate the scar
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Skin care after plaster cast
If you have been in a cast for several weeks, “dead” skin can build up under the cast. Once the cast is removed, you can remove part of the “dead” skin with oil. If the skin is very dry, you can also soak your skin in warm water twice a day, and then use some oil or a cream for dry skin. Rub dry gently with a terry towel, and be careful not to damage the new skin.
Massage of the scar
Massage improves the circulation of the hand and takes care of the scar.
After an operation, you may initiate the massage of the scar after the removal of stitches.
Rotate the skin of the scar, so that the scar is moving. If you do not rub the scar enough, this massage feels painful. After you have stopped the massage, check the condition of the scar from time to time. If the rotation of the scar starts to feel painful again, restart the regular massage.
You can use a cream for dry skin or an oil to the massage.
You can prevent the hypertrophy of the scar with a silicone cream (Kelo-cote). Ask your physiotherapist for more instructions.
8. Swelling
After surgery, the hand was swollen, specially the backside of the hand. About six months later it began to look better, except that the fingers were hooked.
The knuckles were also reddish for a few months. The physical therapist in hospital proposed some drugs, but because I had no pain, I didn’t try them.After the finger and knuckles operation the hand and fingers were swollen again, and most of the swelling decreased after about four months.
Also the PIP-joints thickened in the finger surgery, especially the PIP joint of the little finger, which thinned slowly, taking 15 months. In the ring and middle finger the PIP-joints returned to the normal size after one year.
I didn’t do anything special because of the swelling, but I gave my hand a daily water jet massage. For more efficiency, alternate the temperature of the water, between warm and cold.
Water aerobics and swimming are also likely to be good activities to swollen hand.
9. Strength Training & gym
Hand rehabilitation specialist physiotherapist will give to you instructions and schedule for the strength training.
You can start workout in the gym quite soon after the plaster cast, but adapt the training for the hand, and ask advice from a trainer before you start. Strength training reduces stiffness.
Sometimes the wrist with titan may not like turning or twisting movements when you use bigger weights, in that case modify the exercise so that you keep the wrist straight.
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