Shoulder Sling 101: How to Buy One and How to Wear It
An estimated 70% of the population will suffer from shoulder pain at least once over the course of their lives. Many of these people will use a shoulder sling as part of their treatment. In fact, various injuries, surgeries, and conditions of the arm and shoulder require a shoulder sling. Benefitting from a shoulder sling requires wearing that sling properly.
A properly fitting sling is not too loose or tight. It immobilizes the arm and shoulder at the angle your treatment plan requires. It can also elevate the injured limb to reduce swelling. A sling should not add to your pain. Discomfort signals that your sling needs adjusting.
Do You Need a Shoulder Sling?
Shoulder slings immobilize the hand, arm, or shoulder after injury or surgery. They also provide support for the injured limb or joint. Finally, when the arm is injured, a shoulder sling keeps the limb elevated to reduce swelling.
Patients can benefit from a shoulder sling when they have:
- Fractured a shoulder, elbow, arm, wrist, or ribs
- Sprained a shoulder, elbow, or wrist
- Dislocated a shoulder, elbow, or wrist
- Experienced a rotator cuff tear
- Had surgery on the shoulder, elbow, arm, or wrist
- Suffered a stroke that resulted in paralysis of the arm or hand
Different types of shoulder injuries and surgeries require different treatment plans. However, a shoulder sling figures in many of these plans. Shoulder slings also complement other forms of treatment.
For example, your doctor might cast your fracture but also advise you to wear a sling. In this case, the sling not only supports the injury. It also helps you bear the additional weight of the cast.
A shoulder sling is also versatile enough to accommodate various stages of the healing process.
At the beginning of your recovery, you should expect to wear your sling for most of the day and night. At this point, you'll only remove the sling to bathe and dress. With your physical therapist's guidance, you'll also remove the sling to perform physical therapy exercises. After your therapy session, you'll put the sling back on to once again provide support.
As your healing progresses, you may be able to remove your sling for longer periods of time. At this stage of the process, you might only use the sling for protection when you're most likely to be bumped or jostled.
As you become more active, you'll eventually be able to replace your sling with a shoulder support or brace.
In all cases, however, it's important to follow your doctor's advice about when to wear your sling. Shoulder, elbow, and arm injuries require careful treatment. Without proper treatment, many types of shoulder injuries can recur.
What Are the Different Shoulder Sling Types?
Your doctor might recommend one of several different types of shoulder slings. He might also recommend a shoulder immobilizer. Understanding the different types of shoulder slings helps you locate the best option for you.
The most basic type of shoulder sling is the envelope sling. As the name suggests, this sling envelopes the arm and elbow for support. Doctors most often recommend an envelope sling follow a sprain, dislocation, or fracture. The envelope sling can accommodate injuries that require a cast.
Most envelope slings use a lightweight canvas material for the pouch. This pouch holds the forearm against the body at a 90-degree angle to the upper arm. Meanwhile, the strap distributes the weight of the injured limb across the back. The best envelope arm slings include a shoulder pad for added comfort.
The elevated sling is similar to the envelope sling. However, it usually holds the arm more snugly against the body. It also raises the hand and wrist, positioning the forearm at a 45-degree angle to the upper arm. With this sling, the hand from the injured limb points at the uninjured shoulder.
The elevation this position offers is ideal to reduce swelling in injuries of the wrist and lower arm.
Some patients use athletic slings with a similar design to protect the injured limb while continuing to work out in other ways.
Collar and Cuff Sling
With a collar and cuff sling, you'll wear a "collar" around your neck. Ideally, this collar is padded for comfort. The collar is also connected to a "cuff" that you wear around your wrist.
Together, the collar and cuff support your injured arm and keep it elevated. They also prevent you from making large movements or rotating your injured limb.
The collar and cuff sling is used for injuries that do not require or allow casting. You might also use one after your doctor removes your cast.
Certain elbow braces incorporate a collar and cuff sling into their designs. For example, the adjustable ROM elbow brace lets your doctor position your elbow at the proper angle for healing. Your doctor might adjust this angle as your healing progresses. At every angle, however, a neck strap, or collar, will connect to and support a cuff around your wrist.
Like a shoulder sling, a shoulder immobilizer supports the arm. However, an immobilizer's efforts to prevent movement go further than those of a sling.
Most traditional slings allow the arm to hang loosely in the supportive pouch. With a traditional sling, you'll be able to move your arm out and away from your body. In contrast, shoulder immobilizers secure the arm close to the body. Their design includes bands around your chest, arm, and wrist. The arm and wrist bands are attached to the chest band to immobilize your entire limb.
Some shoulder immobilizers include an abduction pillow to keep the limb secure but lifted away from the body. Abduction pillows are adjustable. Your doctor will recommend adjustments as your recovery progresses.
What Type of Sling Should You Wear After Shoulder Surgery?
Following shoulder surgery, your doctor will prescribe a shoulder immobilizer for the initial stages of your recovery. If your injury and surgery were complex, your shoulder may need extra support. In this case, your immobilizer will likely also include an abduction pillow.
Each patient's recovery is different. However, you can expect to wear a sling for at least 4-6 weeks after surgery.
Your doctor will advise you on removing the sling safely for bathing and dressing. You'll also need to remove your immobilizer to perform range-of-motion (ROM) exercises.
After shoulder surgery, however, it is essential that you not move your shoulder except in the ways your doctor recommends. Reaching, pushing, lifting, or pulling can reverse the gains your surgeon achieved and seriously hamper your recovery. A shoulder sling aims to prevent precisely these harmful movements.
How Should a Shoulder Sling Fit?
Wearing a shoulder sling properly is essential to promote healing. To wear a traditional shoulder sling properly:
- Pull the sling gently over your forearm and elbow.
- Nestle your elbow into the closed end of the sling. The sling should fit snugly but comfortably around your elbow.
- Check the position of your hand. With your elbow all the way to the closed end of the sling, your hand should reach just to the open end. If the sling cuts into your wrist or hand, the sling may be too small. You also need a larger sling if your hand hangs out the open end.
- Secure the strap. Grab the strap that is attached to the elbow end of the sling. Pull this strap behind your neck. Then feed it through the loop by your hand.
- Tighten the strap until the hand and forearm are slightly elevated. This is important to prevent blood from pooling in your hand.
- If the shoulder strap is equipped with a foam pad, position it behind your neck where you feel the most pressure. If your sling did not come with a pad, you can use a piece of foam or terry cloth to cushion your neck.
- Some slings include a swathe or strap to keep your arm close to your body. If your sling includes this strap, pull it around your back. Then secure it near the hand. Finally, check the tightness. The strap should be snug but not too tight. A well-fitting sling with a swathe should permit 2-3 fingers between the strap and your body.
After following these steps, your arm should be positioned securely and comfortably. If you experience discomfort, you will likely need to adjust the sling.
What Are Some of the Most Common Mistakes Patients Encounter When Wearing a Shoulder Sling?
Wearing a sling the wrong way can prolong your recovery. In fact, it can cause more damage.
It's always important, therefore, to follow your doctor's recommendations about how and when to wear a shoulder sling. It's also important to know common mistakes and warning signs of an ill-fitting sling.
Securing Your Injured Limb or Joint in the Wrong Position
A sling is intended to support your injured limb in the position that's best for healing. Securing your shoulder or arm in the wrong position can delay your recovery.
If you're wearing a traditional sling, a proper fit keeps your elbow at a 90-degree angle. If you're wearing an adjustable shoulder or elbow immobilizer, follow your doctor's recommendations for the proper angle.
Failing to do so can put undue stress on the injured limb or joint. It can also contribute to chronic swelling.
Letting Your Forearm, Wrist, or Hand Hang
A sling aims to reduce swelling, especially in your lower arm and hand. However, an improperly fitting sling can let your hand hang down. This allows blood and other fluid to collect in your hand.
While some swelling is a normal part of recovery, excessive and prolonged swelling is not. In fact, prolonged swelling can delay healing and cause muscle atrophy.
If your elbow is not at a 90-degree angle and your forearm hangs down, your sling may be too loose. Try tightening the straps for a more secure fit.
Your hand can also hang down if it doesn't fit inside the sleeve. If this is the case, you'll need a larger sling.
Securing Your Sling Too Tightly
Your sling shouldn't be too loose, but it also shouldn't be too tight. A sling that is too tight can cut off blood flow in your arm and hand. Limiting blood flow, in turn, limits oxygen to the affected limb. Without a supply of oxygen-rich blood, your body will struggle to repair itself. Cutting off the blood flow to a limb can also cause additional tissue and nerve damage.
Signs that your sling is too tight include tingling, numbness, and swelling. Your hand or fingers may also turn blue. If you notice these signs, remove the sling right away. If you're unable to adjust it for a more comfortable fit, seek your doctor or physical therapist's advice.
Not Exercising Your Injured Arm
If you're wearing a sling or even an immobilizer, that means you have an injury that needs support. You shouldn't and can't use your arm to perform many activities of daily living. You also can't leave your injured limb or joint open to being jostled or jarred. At the same time, though, you can't leave your limb to atrophy.
Failing to incorporate any movement into your recovery can lead to muscle atrophy and decreased ROM. These problems can affect the injured limb or joint and surrounding tissues.
Even in the early stages of your recovery, your doctor or physical therapist will help you stay as active as you safely can. Shortly after an injury or surgery, this might mean using a handgrip or therapy putty to keep your arm muscles active.
Under a therapist's guidance, your exercises will gradually incorporate additional movements. Many of these exercises, like pendulum swings, will involve removing your sling for a short time.
Even as you return to your previous activity level, however, your therapist might recommend continuing to support your injury with a brace.
The best shoulder braces and supports are adjustable and made from lightweight, comfortable materials, like neoprene. As such, they are designed to be worn beneath your clothing.
Many are also designed for active use. When you wear a shoulder brace, your joint will experience increased stability even as you become more active. Your injury will also benefit as the support retains heat and provides compression.
At every stage of your recovery, it is essential to follow your doctor or therapist's advice. Always wear your sling or brace when your doctor or therapist recommends it. Never engage in exercises or movements without your doctor's approval. A rushed recovery is often a prolonged recovery.
A Properly Fitting Sling Takes the Weight of the World—and Your Recovery—Off Your Shoulders
A shoulder sling is often necessary after injury or surgery. However, you'll only enjoy the benefits if you wear it properly.
A properly fitting sling fully supports your injury. It is not too tight or loose. It also reduces swelling by keeping the injury elevated. As your recovery progresses, you may find that a shoulder brace balances your need for stability with the need to remain active.