Shoulder Slings and Immobilizers

Support and protection of the shoulder are important after injuries and surgery. Slings and immobilizers hold and safeguard the shoulder during healing. Those of you who have had shoulder surgery know that wearing a sling or immobilizer for several weeks is one of the least favorite parts of the recovery process. Getting the immobilizer on and off can be cumbersome, confusing, and may require some help. Wearing the sling feels unnatural, hot, and uncomfortable. However, use of a sling or shoulder immobilizer is a necessary evil for a good recovery! Mayo Clinic has published a number of videos to review use of slings and immobilizers. Links to these videos are provided below.

Are all slings and immobilizers the same?

Yes and no. Most slings and immobilizers have in common the use of a strap around the neck to help support the weight of the arm. Many immobilizers also include a strap around the waist to further protect the arm from rotating around the trunk. In our surgical practice, we use one of three shoulder immobilizers: the classic shoulder sling, an immobilizer with a small pillow (shoulder abduction sling), and a less common immobilizer with a larger pillow (external rotation brace).

Abduction sling

The abduction sling combines a classic sling connected through Velcro strips to a small pillow that fits the side of the trunk. The forearm rests over the pillow, keeping the shoulder slightly separated off the body. This position, called “abduction”, relaxes some of the structures of the shoulder, protecting them while they heal. The abduction sling also keeps the shoulder in some outward or external rotation, beneficial for some conditions. In addition, the fitting contour of the pillow limits how much the shoulder can rotate around the body. Abduction slings are commonly used for fracture management as well as after rotator cuff repair or shoulder replacement.  Click on the following links to understand how to put on a shoulder abduction sling while seating or standing.

Abduction sling

Classic sling

The classic sling combines a strap around the neck with a strap around the trunk, supporting the shoulder and keeping the forearm resting on the body. The shoulder rests in an inwards or internal rotation position, which may be particularly beneficial after soft-tissue anterior instability surgery and other procedures. Click on the following links to understand how to put on a shoulder sling while seating or standing.

Classic shoulder sling

External rotation brace

Certain procedures benefit from keeping the shoulder outwards in an externally rotated position. This can be achieved with the use of a shoulder immobilizer similar to the abduction sling, but with a larger pillow. This immobilizer, called external rotation brace, is recommended after surgery for posterior shoulder instability, transfer of the lower trapezius, and other procedures. Click on the following link to understand how to put on an external rotation brace.

External rotation brace

How about a shower?

After surgery, you should talk to your shoulder specialist regarding when to take a shower. Some surgeons prefer skin incisions to be completely sealed (about two weeks) before allowing a shower, whereas others find it reasonable to shower within a day or two after surgery. The immobilizers shown above are not ideal to take into the shower: they are bulky and hard to dry when they get wet. We recommend an alternative, very simple, shoulder sling for showers. Click on the following link to understand how to put on a shower sling. Alternatively, it may be safe to take a shower without a sling, just letting the arm by your side. In general, it is not recommended to rub over skin incisions when applying soap and water or when drying. It is best to gently let water run over incisions and to tap incisions dry.

Shower sling

Getting dressed

Getting dressed during the first few days to weeks after shoulder surgery can be a challenge too. The trickiest part is getting a shirt or a pullover on. The combination of discomfort after surgery and the need to protect the shoulder during healing can make getting dressed particularly complicated. Click on the following link to review how to get a shirt or pullover on.

Do I really need my immobilizer all day and night?

When recovering from an injury or surgery, it is typically best to use your sling or immobilizer the majority of the day and night. However, the immobilizer does come off to get dressed,  take a shower, and perform physical therapy exercises. In addition, whenever sitting in a nice chair or couch, it is perfectly reasonable to remove the immobilizer completely and let the forearm rest on your lap. On the contrary, when being active, especially outside, or when going to sleep, the shoulder immobilizer provides protection and should be used. The shoulder immobilizer also functions a sign to others: if you attend a family reunion or a gathering of friends with your immobilizer on, people will be more careful around you!

Most common mistakes when using a shoulder sling or immobilizer

Poor fitting is the most common reason for individuals to be uncomfortable when using their sling or shoulder immobilizer. Slings and immobilizers are manufactured in multiple sizes, and if you were provided with one too large or too small for you, it will just not fit and feel uncomfortable. Even if the size is correct, sometimes the strap around the neck is too long, so that the immobilizer does not really support the arm. The patient then feels the need to hold the weight of the arm through active muscle contraction, which leads to pain around the shoulder and shoulder blade. Finally, abduction slings tend not to fit well in overweight individuals: abdominal fat combined with the thickness of the abduction pillow will result in raising the arm excessively.


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