A Method of Shoulder Spica Cast Application In Shoulder Muscle Transfer Patients In Supine Position

Abstract

Background Children with birth brachial plexus injury (BBPI) often require secondary surgery for the shoulder. The shoulder spica is necessary after shoulder muscle transfer surgery in babies with BBPI. However, its application can be difficult in the supine position under anesthesia. The authors describe a simple and cost-effective method of applying the shoulder spica cast without changing the supine position under anesthesia. Technique While still under anesthesia, the child is placed in a supine position and then elevated on the wooden bar. The POP roll is wrapped around in a cylindrical manner, starting from the level one inch above the anterior superior iliac spine. The contralateral shoulder is also incorporated into the cast. Conclusion The spica application technique described comprises commonly available materials, such as a wooden plank, pair of bolsters, plaster of Paris rolls, and dressing materials overcoming the need for customized apparatus or the operation table. The materials are easy to assemble and thereby applicable just about anywhere. The task also becomes less challenging for the anesthetic in the supine position. This technique is easily reproducible and cost-effective.

Novel Use of a Shoulder Spica: Treatment for Midshaft Humerus Fracture in the Presence of Limb Deficiency

“…Historically the technique has been described in articles dating back to the 1920s as a means to supply an abduction orthotic in the management of humeral and shoulder pathology [ 12 ]. One of the most detailed uses of a shoulder spica is by Shah et al, who outlined the use of shoulder spica casts in neonates undergoing shoulder muscle transfers [ 13 ]. They challenged the need for expensive equipment in order to apply the cast and presented a cost-effective technique.…”

“…Caution was taken to provide room for chest expansion. Other uses for shoulder spica casts include hemivertebrae excision and brachial plexus surgeries including intervention for obstetric brachial plexus palsy [ 13 , 14 , 15 ]. A shoulder spica cast has also been used along with surgical intervention for a proximal humerus fracture with associated shoulder dislocation [ 16 ].…”

Birth Brachial Plexus Palsy: An Indian Perspective

“…A detailed description of the methodology of applying the shoulder spica cast has been elaborated by Shah et al in 2020. 31 This spica is worn for 4 to 6 weeks, after which a controlled rehabilitation program is started by a hand physiotherapist, which includes active and passive range of motion exercises along with strengthening exercises. An elbow extension splint is used to prevent flexion of the elbow during active shoulder abduction.…”