Editorial

“Doctor, can I drive?”: The need for a rational approach to return to driving after musculoskeletal injury

There is limited research to guide physicians and patients in deciding whether it is safe to drive while wearing various forms of upper extremity immobilization. The purpose of this study is to evaluate the effect of below-elbow removable splints and fiberglass casts on automobile driving performance.

20 healthy subjects completed 10 runs through a closed, cone-marked driving course while wearing a randomized sequence of four different types of immobilization on each extremity (short arm thumb spica fiberglass cast, short arm fiberglass cast, short arm thumb spica splint, and short arm wrist splint). The first and last driving runs were without immobilization and served as controls. Performance was measured based on evaluation by a certified driving instructor (pass/fail scoring), cones hit, run time, and subject-perceived driving difficulty (1–10 analogue scoring).

The greatest number of instructor-scored failures occurred while immobilized in right arm spica casts (n = 6; p = 0.02) and left arm spica casts (n = 5; p = 0.049). The right arm spica cast had the highest subject-perceived difficulty (5.2 ± 1.9; p < 0.001). All forms of immobilization had significantly increased perceived difficulty compared to control, except for the left short arm splint (2.5 ± 1.6; p > 0.05). There was no significant difference in number of cones hit or driving time between control runs and runs with any type of immobilization.

Drivers should use caution when wearing any of the forms of upper extremity immobilization tested in this study. All forms of immobilization, with exception of the left short arm splint significantly increased perceived driving difficulty. However, only the fiberglass spica casts (both left and right arm), significantly increased drive run failures due to loss of vehicle control. We recommend against driving when wearing a below-elbow fiberglass spica cast on either extremity.