Cast Guidelines/Upper Extremity
Cast Guidelines/Upper ExtremityRecommendations Regarding PE, Recess & Sports Participation for Elementary School Students Wearing an Upper Extremity Cast, Splint or Other Unusual Supportive Device
By Michael Fragen, MD, FACSM, Sports Medicine, Advocate Medical Group
The principle objectives of the guideline are to:
1) Insure the safety of all participants in the above activities.
2) Allow participation without undo risk to the injured student.
3) Empower the PE teacher, coach, or playground supervisor with the appropriate information to make decisions regarding activity restrictions.
4) Work within the authority of the treating physician.Guideline:
1) To be eligible to participate in PE, Recess or Sports while wearing a cast, splint or other unusual supportive device containing metal, plaster, fiberglass, or hard plastic, the student must obtain permission from the treating physician in the form of a written note.
2) Specific activity restrictions should be allowed when the staff is not unnecessarily burdened by the need to insure compliance with the restrictions.
3) The supportive device should be inspected to insure that no sharp edges are exposed. Devices should be replaced or modified by an appropriate health care professional (Athletic Trainer, Nurse, Physician, Orthotist, Chiropractor, etc.) prior to allowing participation when sharp edges are exposed on the unusual supportive device.
4) In general, all non-contact activities that do not directly require the upper extremity may be allowed, e.g. running, jumping, skipping, etc. No additional protective materials or coverings are required for these activities.
5) When the non-dominant extremity is involved, the dominant extremity may perform several task specific functions, e.g. throwing, holding and using a racquet, etc. No additional protective materials or coverings are required for these activities.
6) For contact or collision sports, supportive devices should not be allowed where the skill level required and the involved joint restriction would unnecessarily put the student at risk of a second injury, e.g. Baseball, Most Gymnastics Skills, Basketball, etc. A sports physician should be consulted to settle disparity between the opinions of staff, students, and parents.
7) For contact and collision sports, one inch of industrial quality foam should cover all metal, fiberglass, plaster, silactic material, or plastic parts of the Unusual Supportive Device. The ideal cast material for participation is made of Silastic Material (Hard Rubber) and covered by 1 inch of foam and should be required for continuous upper extremity contact sports like football, basketball, etc. Several preformed splints are covered with various cushioning materials, e.g. leather/foam combinations that are usually adequate. The immediate supervisor of the physical activity should use their best judgment and request the application of added cushioning when there is concern.
8) No student wearing a supportive device should be forced to participate in an activity where they feel limited in skill or confidence to perform the required tasks.
9) Any student found to be using the Unusual Supportive Device to his/her advantage or in a manner deemed to be inappropriately aggressive should be immediately removed from all school physical activities until the device is no longer required. Additional disciplinary actions may be appropriate.
* This guideline is consistent with the rules of the NHSA, NCAA and the NFL
Correspondence Address:
Michael Fragen, MD, Endeavor, 701 Lee Street, Suite 100, Des Plaines, IL 60181, 847-795-2833
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