As athletic trainers our goal is to prevent injuries however, in active and athletic populations, injuries are almost inevitable to some extent. The athletic trainer must then switch roles into immediate care and long term treatment. Our goal then shifts to helping the individual make a full recovery with as little time loss from sport as possible. The use of playing casts for hand and wrist injuries has contributed to decreasing the time lost from sport. (2) There are many injuries and reasons why an individual may want to utilize a playing cast to try and finish a season.
Some examples of hand and wrist Injuries that patients get casted and play:
Bennett's fracture (Base of the thumb metacarpal)
Thumb metacarpal shaft fx
Thumb proximal phalanx fx
Thumb distal phalanx fx
Metacarpal shaft fx
Proximal/middle/distal phalanx fx
Small finger carpometacrapal fx dislocation
The use of playing casts in football is not an issue at the secondary, college or professional level where the rules allow for the use of hard material with padding. (2) The rule is that the device must be covered on all exterior surfaces with no less than 1/2 in thick high density closed cell polyurethane or alternate material of the same minimum thickness and similar physical properties. At the secondary school setting, the player is required to present the contest officials with written verification from a "licensed medical physician" attesting to the necessity of the playing cast to protect an injury. (2), (3)
Athletic trainers then become tasked with balancing the goals of the patient, the rules of the sport and the recommendations of the surgeon to find a reasonable way to finish a season without causing additional harm to the injured extremity. (3) Once an injury is diagnosed, the sports medicine team must deliberate on what the injury is, the severity level and the urgency for surgery. If the team agrees that surgical intervention can wait until post-season, then it is up to the team to work together to get the individual appropriately casted, and protected for games and practices. After 10 days, an injury should have sufficient callus present for the fracture to be considered stable enough to be removed from its original cast and placed into a temporary cast for games or practices. (3) This is one method of allowing protected return to play, however constantly changing casts is costly, and time consuming, requiring a trained professional with a thorough knowledge of converting everyday splints and casts into game day, sport-approved protective immobilization. In some settings with a limited budget or personnel, such as the secondary school setting, the team may opt to keep the same cast and change the protective padding before games and practices instead.
In some cases, opting for surgery and subsequent rehabilitation in the immediate setting can actually allow the athlete to return to play more quickly than choosing nonoperative treatment, which may lead to surgery at a later point in the season. (3) Similarly, playing with a playing cast comes with it's own risks. The patient needs to understand that complete protection of the injury in all situations of participation is not guaranteed, and playing with any injury is inherently risky.(3) Protected return to play requires creativity among the treatment team by the physician and athletic training staff, as well as the necessary materials. (3)
According to the National Athletic Trainers Association, ATCs are qualified to perform the following physician extender tasks: blood pressure, pulse, patient history, splinting and casting, crutch fitting, gait training, therapeutic exercise and rehabilitation, constructing orthotics, and injury assessments (1) Athletic trainers working in clinic settings or as physician extenders will likely see and cast more patients that athletic trainers in other settings. This is due to the fact that many patients get sent to the clinic for follow-up evaluation and imaging, and if a fracture or injury is found, the individual will likely get casted ASAP at the clinic. An exception to this is professional sports and large colleges with increased personnel and budget. For example, many division 1 football programs have immediate access to x-ray imaging and casting materials and are able to identify, protect and treat injuries in house.
Overall, we as athletic trainers have the training and education to cast individuals and help them return to sport with the necessary protective equipment, but the extent to which this skill is utilized largely depends on the patient population, clinical setting and available resources.
(1) Sampled M, Returned M. Orthopedic surgeons’ perceptions of athletic trainers as physician extenders. Athletic Therapy Today. 2007:29.
(2)DeCarlo M, Malone K, Darmelio J, Rettig A. Casting in sport. Journal of athletic training. 1994;29(1):37.
(3)Carruthers KH, O’Reilly O, Skie M, Walters J, Siparsky P. Casting and splinting management for hand injuries in the in-season contact sport athlete. Sports health. 2017;9(4):364-371.
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