Name of the Procedure:

Casting for Shoulder – Adult (11 years +), Fiberglass Cast (HCPCS Code: Q4004)

Summary

This procedure involves applying a fiberglass cast to an adult's shoulder to immobilize it due to fractures, dislocations, or other injuries. The cast provides support and keeps the shoulder in place to facilitate proper healing.

Purpose

• Medical Conditions or Problems it Addresses:

  • Shoulder fractures
  • Shoulder dislocations
  • Post-surgical immobilization
  • Severe sprains or ligament injuries

• Goals or Expected Outcomes:

  • Stabilize the shoulder area
  • Allow bones and soft tissues to heal properly
  • Prevent further injury
  • Reduce pain and swelling

Indications

• Specific Symptoms or Conditions:

  • Pain, swelling, or deformity in the shoulder area
  • Inability to move the shoulder without significant pain
  • Medical imaging indicating fractures or severe injuries

• Patient Criteria or Factors:

  • Age 11 years and older
  • No contraindications to casting or fiberglass materials

Preparation

• Pre-procedure Instructions for the Patient:

  • Wear loose, comfortable clothing that can be easily removed
  • Inform the healthcare provider of any allergies, especially to casting materials
  • Plan for someone to drive you home, if outpatient

• Diagnostic Tests or Assessments Required:

  • X-rays or other imaging to diagnose the extent of injury

Procedure Description

1. Assessment and Diagnosis:
   • The shoulder injury is assessed, often using imaging tests.
2. Preparation:
   • The skin in the shoulder area is cleaned, and a protective sleeve may be placed around it to protect the skin.
3. Casting:
   • A layer of soft padding is applied.
   • Fiberglass casting material is soaked in water and molded around the shoulder, forming a rigid structure as it dries.
4. Final Adjustments:
   • The cast is smoothed and shaped to ensure comfort and durability.
   • The healthcare provider checks for proper fit and comfort.

• Tools, Equipment, or Technology Used:

  • Fiberglass casting material
  • Soft padding
  • Medical gloves
  • Water for activation

• Anesthesia or Sedation Details:

  • Typically, no anesthesia or sedation is required, though local anesthesia may be used in cases of severe pain.

Duration

The procedure typically takes around 30 to 60 minutes, depending on the complexity of the injury.

Setting

The procedure is usually performed in an outpatient clinic or an emergency department.

Personnel

• Healthcare Professionals Involved:
  • Orthopedic surgeon or trained physician
  • Nurse or medical assistant

Risks and Complications

• Common Risks:

  • Skin irritation or pressure sores
  • Allergic reaction to casting materials

• Rare Risks:

  • Improper healing if the cast is not applied correctly
  • Compartment syndrome (swelling causing pressure in muscles)

• Possible Complications and Their Management:

  • Regular check-ups to ensure proper healing
  • Immediate medical attention if severe pain, swelling, or numbness occurs

Benefits

• Expected Benefits:

  • Effective immobilization for proper healing
  • Pain relief and reduced injury severity
  • Increased chance of full functional recovery

• Realization Timeline:

  • Immediate support to the shoulder area with gradually realizing benefits as healing progresses, typically over 6-8 weeks.

Recovery

• Post-procedure Care and Instructions:

  • Keep the cast dry and clean
  • Avoid putting pressure or weight on the cast
  • Use a sling if recommended
  • Follow up regularly for cast adjustments and evaluations

• Expected Recovery Time and Restrictions:

  • Full recovery generally takes 6-8 weeks
  • Restrictions may include avoiding heavy lifting or strenuous activities

Alternatives

• Other Treatment Options Available:

  • Surgical intervention for severe cases
  • Sling or shoulder brace

• Pros and Cons of Alternatives:

  • Surgery:
    • Pros: May be necessary for severe or complex fractures.
    • Cons: Invasive with longer recovery time.
  • Sling/Brace:
    • Pros: Less restrictive, easier to manage.
    • Cons: May not provide enough support for severe injuries.

Patient Experience

• During the Procedure:

  • May feel pressure and slight discomfort as the cast is applied.

• After the Procedure:

  • Initial stiffness and minor discomfort as the cast hardens
  • Pain management typically involves over-the-counter analgesics
  • Possible itching under the cast which can be managed by maintaining dryness and cleanliness