My two year old daughter has had a series of surgeries on her left arm that required large casts and splints. I tried a few things with success. First, I did make a bedtime story pajama top for her hospital stay, leaving the left side seam and the arm seam open. I finished them separately and put ribbon ties along the side and arm to tie together. I can’t say that they stayed together very well, but they served their purpose. I think better ties rather than slippier ribbon would work better. My next attempt involved opening the seam along the arm of a purchased sweatshirt – I zigzagged along the cut edges, then connected the arm piece to itself with a few short pieces of elastic that I stitched to each side. This was more successful and stayed on better. Had I had more time, I would have tried that with the bedtime story top, which I love and would definitely look like a real shirt in the proper fabric. Another style I had success with was a peasant top. I used the Carla Crim Portrait Peasant pattern from youcanmakethis.com, but there are tutorials on the web, too. I just measured the elastic for the wrist based on her cast circumference and she has gotten a lot of wear out of that (it’s great for pajama tops too). I recommend buying boys’ white tank undershirts to go under any tops you take apart in this way – they’re stretchier than the girls’ versions and make good underlayers.
You might give the 2+2 top a try, since it buttons up the back.
Good luck! I’m anxious to see other people’s suggestions – I’ll be customizing clothes for my little one for a long time.