Shoulder Spica Cast Care

What is the Purpose of a Shoulder Spica Cast?

A shoulder spica cast is used to help support the shoulder after surgery or injury while it heals. It may also be used to stretch a tight shoulder. The cast is usually applied in the operating room while your child is sleeping.

How do I Care for my Child while in a Shoulder Spica Cast?

Bathing

• Keep the cast dry at all times
• DO NOT place your child in a bathtub or sink – sponge bathe only
• Place plastic bags over the cast and use adhesive tape for the edges to keep it dry while sponge bathing
• Check your child’s skin at bath time
• Look for red areas (i.e., spots where the cast could be rubbing). These spots are commonly found between the thumb and index finger and on the back of the belly band
  • Cast padding can compress and move, leaving sharp edges
• If you find sharp edges, place moleskin or other padding between your child and the cast to protect the skin (Padding the cast edges is called petaling. See below for more information.)

Hygiene

• DO NOT allow your child to pick at the cast or cast padding
• DO NOT use oils near or inside of cast
• DO NOT let your child stick anything inside of the cast. When you check the skin around the edges, look for objects that do not belong in the cast
• Clean the outside of the cast with a slightly damp wash cloth if it becomes dirty
• Call your doctor if there are any skin problems or concerns

Feeding

• Cover the cast with a towel while eating to avoid food and stains

Diapers

• Tuck diapers UNDER the belly band

Clothing

• Wear big T-shirts or tank tops
• Oversized zip-up sweatshirts work well to keep warm (football, skiing, snowboarding, skating, etc.)

Summer Months/Warm Weather

• Dress your child lightly
• Your child may be more comfortable in air conditioned areas
• Sweating under the cast could cause itching. If your child complains of itching, you may use a blow dryer (on cool setting) to blow cool air under the cast

Car Seat/Transportation

• Bring your car seat on the day of surgery
• Most children fit in their car seat without any modifications
• Support the child’s head, neck and back (above the waist band), with a towel or blanket if needed for comfort

Circulation

Check for good circulation via the following steps:

• Press gently on a fingernail on the cast arm. The fingernail should turn white
• Let go of the nail. It should turn pink again
• If the nail does not turn pink, change your child’s position. Wait for a few minutes and check the fingernail again
• If the fingernail remains white, blue or gray, call your doctor’s office immediately

Petaling the Cast Edges

• Petaling means covering the rough edges of the cast to protect your child’s skin. There are different kinds of adhesive padding. Some doctors use an adhesive dressing called moleskin
• The cast will be petaled (as needed) in the hospital after it is dry. At home, you may change the petal or strips whenever they become wet or soiled

When to Call Your Doctor

Call your child’s doctor, if your child has any of the following symptoms:

• Red skin and/or sores on the skin around the cast edges
• Numbness or tingling in the hand or arm
• Blue or gray color in the fingers
• Cold fingers
• A strong foul odor from the cast
• Persistent abdominal discomfort
• Nausea and/or vomiting for 48 hours
• Complaining that this cast is too tight
• Complaining of pain that does not go away
• Crying that cannot be comforted

Surgical incisions are cared for by the medical team only; please leave all bandages in place unless otherwise instructed.

Scar Management

• Begin scar massage 2 weeks after surgery when the incision is completely closed (no scabs or stitches present)
• Use unscented lotion or oil (e.g., vitamin E, cocoa butter) and apply gentle pressure with your fingers, moving in a small circular motion over the scar
• Scar massage should take place 4 times per day for 5 minutes each time
• If your child will be outside in the sun, apply at least SPF 35 or cover scars for 1 year to reduce darkening of the tissue

Therapy / Exercises

• Therapy begins 1-2 weeks after the cast is removed. This gives your child time to adjust without the cast. This process can take 2-3 days and can be uncomfortable at first
• Therapy begins slowly on restoring range of motion of the arm and will progress to strengthening when your child is cleared by their surgeon
• We recommend that children who have recently had their cast removed attend therapy 2-3 times per week for the first month to ensure their joints do not become stiff. This can be decreased over time as they progress in therapy