Management of intolerance to casting the upper extremities in claustrophobic patients.
BACKGROUND
Some patients showed unusual responses to the immobilization without any objective findings with casts in upper extremities. We hypothesized their that intolerance with excessive anxiety to casts is due to claustrophobia triggered by cast immobilization. The aim of this study is to analyze the relevance of cast immobilization to the feeling of claustrophobia and discover how to handle them.


METHODS
There were nine patients who showed the caustrophobic symptoms with their casts. They were assesed whether they were aware of their claustrophobis themselves. Further we investigated the alternative immobilization to casts.


RESULTS
Seven out of nine cases that were aware of their claustrophobic tendencies either were given removable splints initially or had the casts converted to removable splints when they exhibited symptoms. The two patients who were unaware of their latent claustrophobic tendencies were identified when they showed similar claustrophobic symptoms to the previous patients soon after short arm cast application. We replaced the casts with removable splints. This resolved the issue in all cases.


CONCLUSIONS
We should be aware of the claustrophobia if patients showed unusual responses to the immobilization without any objective findings with casts in upper extremities, where removal splint is practical alternative to cast to continue the treatment successfully.
Department of Orthopaedic Surgery, Kobe Rosai Hospital, 4-1-23 Kagoike-dori, Chuo-ku, Kobe 651-0053, Japan.
Issei
I
Nagura
Department of Orthopaedic Surgery, Kobe Rosai Hospital, 4-1-23 Kagoike-dori, Chuo-ku, Kobe 651-0053, Japan.
Takako
T
Kanatani
Department of Orthopaedic Surgery, Kobe Rosai Hospital, 4-1-23 Kagoike-dori, Chuo-ku, Kobe 651-0053, Japan.
Masatoshi
M
Sumi
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 6500017, Japan.
Atsuyuki
A
Inui
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 6500017, Japan.
Yutaka
Y
Mifune
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 6500017, Japan.
Takeshi
T
Kokubu
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 6500017, Japan.
Masahiro
M
Kurosaka
D000328:Adult; D001007:Anxiety / Q000209:etiology / Q000517:prevention & control* / Q000523:psychology; D002370:Casts, Surgical; D019468:Disease Management; D005260:Female; D006801:Humans; D007103:Immobilization / Q000009:adverse effects* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D010698:Phobic Disorders / Q000209:etiology / Q000517:prevention & control* / Q000523:psychology; D013165:Splints; D011795:Surveys and Questionnaires; D034941:Upper Extremity / Q000293:injuries / Q000473:pathology / Q000601:surgery