71.2 Casts, slings, and exercises for injuries of the upper limb

Later chapters start with a description of the appropriate casts. These are seldom needed for injuries of the elbow and almost never for injuries of the shoulder and upper arm. The slings in Fig. 71-1 are important for ambulant patients with injured arms. An injured or infected arm which hangs down is painful—a sling makes it much more comfortable and alows it to be exercised when necessary. Many hospitals supply plaster casts and sell or hire out crutches. They should do the same for slings. A loop of bandage (E, in Fig. 71-1) is not good enough. An important principle in all shoulder injuries is for the patient to start exercising his elbow and fingers as soon as he can. Even in a sling he can do some of the exercises in Fig. 71-7.

Figure 71.2: FRACTURE OF THE MIDDLE THIRD OF THE CLAVICLE. If an adult breaks the middle third of his clavicle, his sternomastoid muscle pulls the medial fragment up, while the weight of his arm pulls the lateral one down.

ACTIVE MOVEMENTS FOR INJURIES OF THE SHOULDER GIRDLE

INDICATIONS (1) All fractures of the clavicle. (2) Most dislocations of the sterno–clavicular and acromio–clavicular joints.

METHOD A sling will relieve the patient’s pain. Make it with a triangular bandage, and rest his arm in it for 2 or 3 weeks, or until the fracture site is no longer tender. Start elbow and finger exercises immediately. Begin shoulder exercises in 2 or 3 days. If his clavicle is fractured, bracing his shoulders back will help him to hold it to length. Encourage him to move his arm as soon as he can.

Don’t leave a sling on too long. Remove it at a set time, some patients develop a’sling neurosis’ and are unwilling to part with it.