A Patient's guide to Shoulder Spica

Your spica should fit comfortably. However, if it is uncomfortable it may cause rubbing or put unnecessary pressure on your shoulder. If this pressure is not relieved you are at risk of developing a pressure ulcer. 
Therefore, you must seek assistance. If your skin is itchy for any reason, do not poke anything down the plaster cast to scratch as this could also cause a pressure ulcer. Under no circumstances should the spica be interfered with or cut away for any reason. It is important that it is kept intact.

Should you experience any areas of discomfort then you must contact Plaster Theatre to arrange an appointment for alterations to be made, 020 8909 5467, Monday - Friday 7:45am - 5pm.

The following symptoms could be a sign a pressure ulcer is developing.
Discoloured skin, pinkish red and/or purple bluish in colour*, which does not go pale when pressed (reddening of the skin that disappears  when pressure is removed is normal and not a pressure ulcer)

• Blisters, dry, cracked, or shiny areas
• Skin may go darker and break down to cause an open wound
• A hard swollen area of skin that may be painful to touch

(* This is not always as obvious in dark skin)

Immediately contact the plaster theatre if you start feeling any of the following:

• Feeling a rubbing or blister-like pain or discomfort within the cast
• Complaining of something wet or sticky inside the plaster cast.
• The plaster cast has developed an unusual smell
• Staining has developed on the outside of the cast
• Areas of pain or local hea

The plaster must remain dry. Depending on your surgery, the top of the arm section may be removable. If so this can be taken off for strip washing purposes only. Using either a damp flannel or baby wipes to access visible skin. Please ensure you dry yourself thoroughly. DO NOT attempt to shower or have a bath as this will damage the spica. Do not use talcum powder or creams as these will become gritty when mixed with sweat which could also irritate the skin and cause a pressure ulcer or infection. 

NO ATTEMPT must be made to move the arm out of the support, as this could compromise the surgery undertaken.

You will need to wear larger clothes e.g. baggy t-shirts, jumpers that will easily go over the spica. Trousers/skirts with elasticated waists will aid comfort. You can adapt clothes by splitting the side seam and adding Velcro fastenings.  

Top of spica arm, showing fastening straps.

You will find the spica heavy and cumbersome to start with and it can affect your balance for the first few days. You will be assessed by a Therapist before you leave hospital to ensure you are safe with walking and transferring on/off chair, bed and toilet.

You will need to sleep either lying flat with the support of a pillow(s) under your head/upper body or on your non-operated side. You will not be able to lie on your operated side and may need to log roll onto your side to get on/off the bed.

If there are any physical activities or leisure activities that you may still want to do whilst in the spica please discuss this with your Therapist. It is important that you remain mobile and as active even if it is only gentle walking.

You will not be allowed to drive whilst in the spica. You must arrange for suitable transport to collect you. Usually it is more comfortable and safer to travel in the back of a car.

Do

• Contact Plaster Theatre with any concerns
• Remain as mobile as possible during the day. Change position regularly to prevent any pressure to any one area. Ensure you continue to move fingers in the cast on a regular basis to prevent any stiffness.
• Check your skin regularly around the edges of the spica. It is important to prevent pressure ulcers developing under the cast If any redness or broken skin is identified, you must contact the Plaster Theatre.
• Eat and drink normally as the cast goes around the waist and is moulded over the hips and should not interfere with your diet. It is advisable to avoid fizzy drinks or excessively large meals as you may feel bloated inside the cast.

Don’ts

• DO NOT attempt to remove, alter or adjust the spica
• DO NOT attempt to drive in the spica
• DO NOT attempt to use any talcum powders or cream under the spica as this can damage the lining and create dampness and possible sores
• DO NOT sit close to a fire, as your spica may become hot and burn you
• Avoid partially lying back as this can push the spica upwards causing discomfort

Contact the Plaster Theatre if:

• The spica becomes damaged, loose or tight
• Your skin feels sore, “blister like pain” or rubbing ou notice any abnormal smell, discharge or wetness under the spica
• You feel any pins and needles or numbness to limb or fingers
• Your limb becomes more painful
• You drop any object down the spica i.e. hair grip, earring
• You have any concerns and think there may be a problem 

Plaster Theatre
Telephone: 020 8909 5467
Monday to Friday 7:45am to 5pm.

If you experience any significant changes in swelling, sensation and skin colour out of these hours please contact your local emergency services and inform the above number as soon as possible. 

Any adjustments that are made should be carried out by the Plaster Theatre team at the RNOH as some adjustments may be detrimental to the surgery.