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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Recovering From Scaphoid Fracture Surgery. Pain Due To Tight Cast, Losing Feeling In Thumb. What To Do?

I am recovering from surgery required due to a scaphoid fracture. I am 9 weeks out from surgery now. After 6 weeks, my doc switched me from a plaster cast to one of the new Exos casts (long thumb). This cast is much more uncomfortable than the plaster cast, because there's no padding and it gets extremely hot and sweaty. However, the worst part, which is almost intolerable for me, is that the cast is extremely tight around my thumb, and is causing me a lot of pain. I've lost some of the feeling in my thumb and it hurts all the time. I went back to have it adjusted after two weeks, because I couldn't handle the pain, and the tech cut the thumb section down a bit, but it is every bit as painful as before. It is so tight around my thumb, it makes me think of a cork in a wine bottle! When I remove the cast to shower, I have to pull my thumb hard to get it out of the thumb opening, and I feel as if I'm reinjuring it every time. Both techs who have fit the cast for me have told me that the thumb is supposed to be tight, but this seems crazy. I'm tempted to call tomorrow and just ask them to put me back in a plaster cast, if it's inevitable that the thumb opening has to be this tight. Maybe I'm just being wimpy, though. Not sure what to do...
Fri, 26 Jul 2013
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Orthopaedic Surgeon, Joint Replacement 's  Response
Hi, thanks for writing to HCM.

I personally feel that there is no need of a plaster cast or any other splinting after 9 weeks of scaphoid fixation (provided the fixation has been anatomical).

Any cast or splint applied too tightly will cause pain , swelling, numbness and inadequate blood supply to the part at times endangering the limb.

A cast or splint should be of just adequate tightness to allow the free movements of the joints adjacent to it.

Consult your treating doctor for any more issues.

Hope this information is helpful . Good day
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General & Family Physician Dr. Dr.Alekhya's  Response
hello,
Thank you for the query.The symptoms you have mentioned are due to tight cast as it is compressing nerves under so consult you doctor again and have an X-Ray done.It seems like compartment syndrome it is good for to be treated early.Thank you.
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Recovering From Scaphoid Fracture Surgery. Pain Due To Tight Cast, Losing Feeling In Thumb. What To Do?

Hi, thanks for writing to HCM. I personally feel that there is no need of a plaster cast or any other splinting after 9 weeks of scaphoid fixation (provided the fixation has been anatomical). Any cast or splint applied too tightly will cause pain , swelling, numbness and inadequate blood supply to the part at times endangering the limb. A cast or splint should be of just adequate tightness to allow the free movements of the joints adjacent to it. Consult your treating doctor for any more issues. Hope this information is helpful . Good day