The information provides advice on caring for your plaster cast, synthetic cast and splint. These applications help to immobilise an injured limb after fractures, sprains, ligament tears and other injuries.

Do’s:

  • Raise your injured part using pillows to reduce swelling.
  • Observe for change in nail bed colour of your injured part eg: from pink to blue.
  • Take painkillers when in pain.
  • Exercise your exposed fingers/toes of your injured part to prevent stiffness/swelling.
  • Keep your cast/splint clean and dry to prevent skin irritation.
  • Cover your injured part with plastic before a shower to prevent cast/splint from getting wet.
  • Use a fan to dry the inner cast/splint if it is wet or damp.

Do’s (Upper Limb)

  • Support your injured hand in an arm sling.

Arm Sling

Do’s (Lower Limb)

  • Always sit on a chair and place your injured leg on another chair when showering.
  • Use crutches/wheelchair as instructed for your own safety.

Don’ts

  • Do not put weight on the injured part unless advised by the doctor.
  • Do not wet your cast/splint.
  • Do not put powder or any object in your cast/splint.
  • Do not attempt to loosen or shorten your cast/splint.
  • Do not scratch your skin underneath your cast/splint using sharp object.

If you experience any of the following:

  • Swelling
  • Discolouration
  • Tingling sensation or numbness
  • Increasing Pain
  • Skin rubbing in the cast/splint or broken skin around the edges
  • Cast/splint feels too tight or loose, broken or cracked
  • Cast/splint is soaked or soiled

If your cast/splint was applied at Singapore Sports and Orthopaedic Clinic:

Please call +65 64712674 for an appointment to see your treating doctor.

If your cast/splint was applied at another place and wish to be seen by our doctor:

Call us today to book your appointment.

+65 64712674

Line is open 24 Hours.

 

Good hand function depends on healthy and intact bones and joints. 31 bones from the skeleton of the hand and wrist. Between the bones are joints that allow the fingers and wrist to move. Muscles and tendon attach to the bones, moving the joints when they contract and relax. The nerves and blood vessels are supported and protected by the solid bones.

Hand Anatomy

With sudden forceful impact or twisting, the bones may break causing a fracture. This can happen when one breaks a fall with the hand; during sporting activities particularly contact sports such as marital arts, basketball or football; in traffic accidents, or when working with tools. When this happens, pain, swelling and deformity will severely impair hand function. In more severe injuries, the soft tissues such as nerves and blood vessels may be injured, jeopardising the entire finger or hand. All fractures and dislocations must be treated quickly and properly to ensure that good hand function is restored.

How do I know if There is a Fracture?

If you have hit or twisted your finger or wrist, or fallen hard on your hand, you may have fractured a bone. If the hand or wrist is obviously deformed and looks abnormal, then there is probably a bad fracture or dislocation. However, even if there isn’t any obvious deformity but there is swelling, bruising and pain when trying to move a finger or wrist, then you should suspect there is a fracture.

Wrist Fracture

When Should I see a Doctor?

If you think you may have a fracture or dislocation, it is important to see a doctor as soon as possible to have an X-ray taken. X-rays show the bones and joints under the skin, revealing any breaks in the bone or dislocated joints. You should see a doctor immediately if you also have an open wound, numbness in the injured finger or hand, or if the injured finger is turning blue or pale. These are signs that there is also injury to the skin, nerves and blood vessels respectively, all of which need urgent surgical treatment.

Can I use traditional or “alternative” medicine instead?

You should never allow a “bone setter”, chiropractor or traditional medicine practitioner to manipulate an injured finger, hand or wrist without an X-ray confirming that there isn’t a fracture or dislocation.

Such manipulation may cause more injury or delay the diagnosis, making the treatment more difficult and the outcome poorer.

How are the fractures treated?

All fractures require immobilisation of the bone to allow it to heal. Usually, healing takes six weeks for adults and three to four weeks for children. During this time, the broken bone ends and the joints at either end of the fractured bone must be immobilised. Fractures that are displaced or deformed need to be manipulated to make the bone straight and bring the ends together to allow them to heal without deformity. The most common way to immobilise the fracture is to put the hand or wrist in a cast. However, some fractures are too unstable and may shift in the cast. A surgery called “open reduction internal fixation” or ORIF is needed to fix them with metal wires, plates or screws. ORIF is also necessary when perfect alignment is needed. Even simple fractures that are not badly displaced can benefit from ORIF, which allows immediate use of the hand, instead of putting it in a cast for four to six weeks.

Physical therapy is frequent needed after the fracture heals to regain mobility, strength and function in the hand. If the fracture has been fixed surgically, therapy starts immediately after surgery, without waiting for it to heal, as the metal implants prevent the fracture from moving. This allows much faster return to full function.

What is the outcome?

It is vital for hand and wrist fractures to be treated by an experienced orthopaedic surgeon. Poorly fixed or badly managed fractures result in permanent deformity and stiffness, greatly impairing hand function. More complex surgery may be needed later to correct the deformity and restore function. If diagnosed and treated appropriately, most fractures heal with minimal deformity and goof hand function can be expected.

Call + 65 6471 2674 (24 Hour) to fix an appointment with our doctor to treat Fractures today.

The “50-year-old shoulder”

In Chinese and Japanese, the “50 Shoulder”, or sometimes also called the “40 shoulder” refers to pain and stiffness of the shoulder occurring without any apparent cause. It is not confined to the 50 year old. and may occur typically in the 35-65 age group. This is also known as the Frozen Shoulder (or Adhesive Capsulitis in medical terms). However some of these patients may have Rotator Cuff Disease or even Osteoarthritis, both of which also present as pain and stiffness. In many of these cases, the symptoms overlap with the frozen shoulder and some form of imaging (X-rays, Ultrasound or MRI scans) may be needed to differentiate them.

 

Frozen Shoulder

The Frozen Shoulder is a problem involving the shoulder capsule. This is basically a balloon that surrounds the joint, the primary function of which is to hold in the joint fluid. This balloon gets thickened and inflamed in a frozen shoulder resulting in the pain and stiffness. The Rotator Cuff is actually a number of muscles which surround the shoulder ball, sitting just outside the capsult. It is commonly inflamed (tendonitis) or even torn in this age group. Arthritis is damage to the joint cartilage itself.

Usually, the pain starts gradually. In some cases, there may some form of mild injury or overuse, but in most case, the patients cannot remember any precipitating event. The shoulder becomes stiffer and more painful over the course of a few weeks to months.

The natural history of a frozen shoulder is that it eventually gets better on its own in most cases, but may take anything from 6 months to even 2-3 years. With treatment however, this period can be shortened dramatically. The primary treatment is that of a stretching programme. The majority of patients will respond to home programme of capsular stretching but there are always a few that do not.

Those who have too much pain to stretch, or do not respond, may need further intervention. This can be in the form of a simple Manipulation, under Anaesthesia or an Arthroscopic Capsular Release. This intervention is merely a way to get over the “hurdle” as the patient still needs to continue stretching for 2-3 months after this.

Rotator cuff disease is a spectrum of disease, ranging  from Tendonitis, to Partial Thickness Tears, known as Cuff Tear Arthropathy. The patient with a rotator cuff problem sometimes in a similar way to a frozen shoulder. In others it is due to an injury such as a fall or overuse injury. The symptoms are slightly different, as the pain is more pain on exertion or they may have a painful arc.

The rotator cuff is a set of muscles, surrounding the shoulder capsule. The most commonly involved muscle is Supraspinatus. The treatment depends very much on the patient symptoms, size of tear etc.

For example if the symptoms are just a painful arc (Impingement Syndrome) and the scans are negative for a tear, then non operative treatment is often successful. This may involve a stretching programme, rest, anti-inflammatory medication or even steroid injections. If surgery is needed, it is relatively simple Day Surgery Arthroscopic Surgery in which some bone may be removed to reduce the friction and rubbing on the rotator cuff from the adjacent bone.

On the other hand if there is full thickness tear, the symptoms may be more of weakness and pain on overhead activity. In this case, a Surgical Repair of the Torn Supraspinatus Tendon may be needed. Steroid injections are not recommended as they mask the symptoms only and also may compromise the results of surgical repair.

In come cases, a patient may have both a Rotator Cuff Tear, as well as a form of Frozen Shoulder which occurs secondarily to the Rotator Cuff Disease. This complicates the treatment and usually results in slower recovery.

Call +65 6471 2674 (24 Hour) to fix an appointment with our doctor to treat Rotator Cuff Tears or Frozen Shoulder today.

Brief Outline of Extensor and Flexor Tendinitis

The tendons attached to the muscles that are responsible for flexing and extending the toes and foot can become inflamed and irritated just like any other tendon. Overuse, tightness is opposing muscles, or foot deformities can cause this condition. Extensor tendinitis is more common that flexor, but flexor tendinitis tends to be more painful and debilitating. Dancers are most commonly associated with injury to this tendon group.

Anatomy and physiology

Foot Muscles

The extensor hallucis longus and extensor digitorum longus are the main extensor muscles of the toes. The tendons of these muscles run over the front of the ankle, over the foot and attach to the toes. These muscles dorsiflex the foot and work in opposition to the flexor muscles. When the calf muscles are tight, or the muscles are worked beyond their exertion level, inflammation of the tendon may occur.

The flexor group of muscles, the flexor hallucis longus and the flexor digitorum longus, have tendons that run down the inside of the ankle and under the foot, attaching to the toes. These muscles plantar flex the foot and toes.

Cause of Injury

Extensor tendinitis: Tight calf muscles, over-exertion of the extensor muscles, or fallen arches.

Flexor tendinitis: Repetitive stress to the tendon from excessive dorsiflexion of the toes.

Signs and symptoms

Extensor tendinitis: Pain on the top of the foot, pain when dorsiflexing the toes, some strength loss may be experienced.

Flexor tendinitis: Pain along the tendon, in the arch of the foot, and along the inside back of the ankle.

Complications if left unattended

Tendinitis when left unattended can cause strains to the attached muscle and could lead to a complete rupture of the tendon. The pain may become severe enough to limit all activity.

Treatment

Rehabilitation and prevention

While resting the foot, it is important to identify the conditions that caused the problem. Stretching the calf muscles and the tibialis anterior muscle will help relieve the pressure on the tendons. Warming-up and gradually increasing workloads will help prevent tendinitis. Orthotics may be required when returning to activity to correct any arch problems.

Long-term prognosis

Most people recover completely from tendinitis with simple rest and correction of the cause(s). In some rare cases, surgery may be required to reduce the pressure on the tendons and relieve the inflammation.

Call (+65) 6471 2674 (24 Hour) to make an appointment to see our doctor to treat tendinitis today.

Brief Outline of Frozen Shoulder (Adhesive Capsulitis)

Frozen shoulder or adhesive capsulitis causes severe restriction of shoulder movement due to pain. The condition results from abnormal bands of tissue that form between joints, thereby restricting their motion and producing pain. Synovial fluid – which usually serves to lubricate the space between the capsule and ball of the humerus in the shoulder, allowing smooth motion – is often lacking in this condition. It is more common in females.

Frozen Shoulder

 

Anatomy and physiology

Frozen shoulder involves injury and accompanying loss of movement in the shoulder or glenohumeral joint. The joint consists of a ball (formed by the humeral head) and socket (the glenoid cavity). While the glenohumeral joint is normally one of the body’s most mobile joints, it is inherently unstable due to the gleonoid cavity being only approximately one-third the size of the humeral head, (although it is slightly deepened by a rim of fibrocartilage called the glenoid labrum). The joint capsule appears to be a major cause of movement limitation in this condition. Adhesions of scar tissue forming in joint spaces can restrict movement, causing the shoulder to freeze up, with severely limited range of motion.

Frozen Shoulder Range of Movement Limited

 

Cause of Frozen Shoulder

Scar tissue formation following shoulder injury. Formation of adhesions following shoulder surgery. Repeated tearing of soft tissue surrounding the glenohumeral joint.

Signs and symptoms

Dull, aching pain in the shoulder region, often worsening at night. Restricted movement of the shoulder. Pain and ache when lifting the affected arm.

Complication if left unattended

Frozen shoulder has a tendency to worsen over time without adequate treatment and proper recovery period. Attempted athletic activity, involving the affected shoulder, will likely lead to further adhesions of the joint, with further pain and restrictions of movement. Production of scar tissue may eventually require surgical removal.

Treatment

  • Injection
  • Manipulation under anaesthesia to loosen the joint and break up the scar tissue
  • Key-hole surgery to remove the scar tissue

Rehabilitation and prevention

Most heat should be accompanied by stretching exercises to gradually restore mobility. Heat therapy should be combined with doctor-supervised physical therapy. Moving the shoulder through the full range of motion several times daily, as well as strength training exercises, may help avoid frozen shoulder. Injuries to the shoulder should be given prompt medical attention to avoid formation of scar tissue, where possible.

Long-term prognosis

The length recovery time following frozen shoulder varies depending on the underlying cause as well as the age and health of the athlete, and the history of shoulder injury. If the condition fails to improve after 4-6 months, surgery may be required. Some lasting discomfort and impairment of movement is common with this injury.

Call (+65) 64712 674 (24 Hour) to fix an appointment to treat your frozen shoulder today.