Shoulder Surgery: When Can I Get Rid of My Shoulder Sling?

Rotator cuff repairs, shoulder labral repairs, acromioplasty, humeral fractures, and other shoulder surgeries inevitably require the usage of a shoulder sling as a means of protecting the surgeon’s work and allowing early healing of the involved tissue. I have yet to meet a surgeon who does not prescribe the usage of a shoulder sling immediately following a shoulder surgery.

shoulder slingA shoulder sling will protect the involved arm from sudden jarring motions that the patient might consciously or unconsciously attempt to perform. For example, if a patient momentarily loses his or her balance while walking or while ascending stairs, using the post-surgical shoulder to grab a bannister can easily ruin the surgery.

I have also spoken with patients who have damaged shoulder surgeries during sleep. Although this may at first sound implausible, some people will actually damage a rotator cuff repair as the result of flailing the involved arm during a bad dream. (Pain medication will at times lead to “animated” dreams.) Rolling on to the involved shoulder during sleep will also place undo stress on a surgical recovery.

For these reasons it is a good idea to wear a prescribed sling during the early phases of healing a rehabilitation.

Shoulder sling immobilization comes at a cost

Slings have the potential to pitch the shoulder into an unnatural forward position. Muscles, tendons, and ligaments tend to accommodate to the position that they are placed in, even if they are forced into a position for relatively short periods of time. A forward position of the shoulder tightens the pectoral muscles, tips the shoulder blade into an awkward position, and increases stress on the rotator cuff tendons and ligaments with movements of the arm.

The shoulder also needs to experience the normal, rhythmic swinging movements associated with walking. When we halt this motion for too long, the spine and even the legs can be affected by this forced asymmetry in our motion.

As disturbing as this may seem, wearing a shoulder sling for too long will inevitably place stress on the very structures the sling was initially meant to protect.

Practical tips in regards to shoulder sling usage

1. Ask your doctor what his or her specific protocol is for wearing a shoulder sling. You should also ask your doctor when is the earliest time possible to begin scaling down the amount of time spent in your sling. Do not go against your physician’s orders! I have found, however, that too many patients simply never find out the appropriate time frames and end up wearing the sling for too long.

2. Try to spend some time out of your sling every day in a controlled environment free of obstacles or potential hazards. Allow your shoulder to rest in as normal a position as possible. Use the position of your non-surgical arm as a reference.

3. Realize that there is a psychological hurdle that you must get over in regards to using your arm again. A sling represents protection: It is easy to fall into the trap of wearing it for too long because of the fear of painful and restricted motion.

4. Work on strengthening the muscles that have become weakened from sling usage as soon as your doctor and physical therapist permit such. It is also a good idea to encourage limited and comfortable swinging of the arm with walking. Lying flat on the floor with your shoulders relaxed and your hands folded on your stomach is a great way to gently and passively stretch your chest, spine, and shoulders into a more ideal position.

5. It is not a good idea to stop using your sling “cold turkey.” Gradually wean yourself off the sling. Some people find that removing the sling at home and at the office is a good place to start. The last days of wearing your sling should involve only wearing it in crowds and in public.

6. It is very common to experience neck pain as the result of wearing a sling, even if only for a few weeks. If you are experiencing neck pain, discuss it with your doctor or physical therapist in order to have it addressed.

Discussion

  1. Ricky says

    I had surgery on my right shoulder on June 23rd, 8 days ago. I initially had the surgery to remove a paralabral cyst but also ended up having a Anterior Labral Repair. To my knowledge, I’ve had 3 anchors. I’m in a pretty pony sling, thank you NHS (I’m from England by the way)

    I’ve been instructed to start physiotherapy the day after surgery. The exercises I have been set are as follows #1 clenching fist and relaxing hand (10 reps) #2 elevate wrist and relax (10 reps) #3 rotate forearm back and forth (10 reps) #4 unweighted bicep curl (10 reps) #5 pendulum exercises, rock arm backwards and forwards (10 reps), side to side (10 reps), around in a circle (10 reps) All done on the operated arm only of course. I’m not having too many issues with the exercises and the pain has lessened a lot over the last couple days.

    I suffer a great deal with anxiety, depression and body dysmorphic disorder. I’m very worried about damaging the repair but am also very low because I’m limited to using my left arm only. I’ve been told to stay in the sling for 6 weeks, I’m due a follow this Friday with my orthopaedic. Still, I would like to ask you when you think it’s okay to start doing normal things like, shaving with my operated arm, washing properly in the shower with both arms, cutting up food, styling hair etc. I HATE THIS SLING! I’m going on vacation on August 7th, 5 weeks time and I want to be out of my sling completely, I want to swim and not worry about my shoulder. I didn’t think this was going to be such a do ah. I thought it have the cyst removed and be back to normal within a few weeks, I didn’t expect physiotherapy, I don’t want to be doing exercises for a long time as it’s an anxiety trigger for me, long story!

    I can’t sleep all night in my sling either, I’ve been taking it off in the middle of the night as I wake up and my elbow and wrist ache from being held in the same position, I’ve been sleeping on my back with or without sling, when I take the sling off in the middle of the night I lay a pillow under my operated arm and let it lay by my side, I don’t move around and when I wake I make sure I stay on my back even though I’m gagging to roll around. Do you think I’ll be able to get out of this sling earlier than 6 weeks and be sling free by August 7th? And be able to do normal day to day things as mentioned earlier. I want to be able wear my new polo shirts on holiday and put them on myself, they’re slim fit, is this a logical expectation?

    Best wishes,

    Ricky

    • says

      I think that the pillow thing that you describe should suffice in terms of sleeping comfort. Let us hope that you are not a thrasher when you sleep.

      You can plead with the doc about ditching the sling, but it really is his call. At the very least you should be wearing it in public and when you travel. I do think that it is reasonable to be rid of the sling by the beginning of August. You should certainly be able to (carefully) don and doff your polo shirts as well by that time. Don’t freak out, you will get there.

      • Ricky says

        Thank you for your reply :-))
        When is it acceptable to start brushing my teeth, preparing and cutting up food, having a shave, washing my self, you know normal day to day tasks with my operated arm? Like I said in my last message, I had mild discomfort and pain pre op, no dislocations etc. and my orthopaedic only performed the op because I wanted the paralabral cyst out because I thought, why not, It could be the cause behind my aching. Before the op I had good if not perfect ROM, the pain was just more of a general aching, that was never worsened by strenuous activities, I just had a regular and annoying ache in my shoulder and down my arm, when out walking and in just general day to day tasks.

        Will I be doing physiotherapy for ages? Do you think swimming is something I’ll be able to do when I am on vacation in 5 weeks time?

        I would never have thought losing use of my dominant arm would be this annoying and hard. I thought I’d be back to normal at two weeks max. Another thing how long would you have to be wearing a sling for it to cause/worsen shoulder symmetry or will a sling not do that?

        A few questions in that message I know, thanks again for you help and advice.

        Best wishes,

        Ricky

        • says

          Daily activities such as the ones that you have mentioned are usually cleared by about 2-4 weeks. Take your time doing them and make sure that you are flexing your elbow so that the shoulder is not having to do the work.

          PT can last for up to 4-6 months depending on how things go. It totally depends on your progress. You will not be overhead stroke swimming in August, too risky. Wading around in the water should be fine.

          Sling wear can change neck and shoulder mechanics within a few weeks. It is annoying but it is a necessary evil to allow the anchors to heal in to place.

  2. Vaida says

    Hi,

    I fractured my elbow in two places, both fracktures are about 1cm long. I’m travelling around Asia and went to the hospital that had no English speaking doctors or nurses so I want to get another opinion. I was told to wear a sleeve for 3 weeks and proceed as normal afterwards. Since I been reading a lot about it I gathered some information such as that you have to wear the sleeve for 6-8 weeks, that you are not supposed to take it off early or you can do it only for couple of hours a day also that I should do some stretching but that has to be discussed with your physiotherapist that I cannot get here.

    My arm is getting better but I would like to know if there are some things I should avoid or should do to help it heal faster.

    Thank you!

    • says

      Vaida it all depends on where exactly the fractures are located. The “radial head” portion of the elbow actually does not need to be in a sleeve for as long as fractures in other areas. Given that we do not know exactly where the fracture is, you can probably stick to the recommendation of the doctor.

  3. Amanda says

    Hi there,

    Was wondering if I could have a bit of advice also please,

    I had an open capsular shift 5 weeks ago today, been in an immobiliser sling since surgery and was told in hosp no physio for 6 weeks, only hand wrist exercises.

    I do feel safe with my sling but my elbow and wrist is in agony, I take it out and support a cusion underneath a few times a day but as soon as I bend my elbow again I feel like my whole arm hurts. Is this normal wearing an immobiliser or has something not went quite right?

    I see my constant for the first time since surgery I n Friday and I am going to ask if I can have the sling off and physio early, I also have an important event I am going to in 10 days, if I did get the all clear to come out the sling on Friday, would it be ok to go out in public without the sling or is there a longer period that you are supposed to weane yourself off it?

    Thanks for reading and any help would be greatly appreciated.

    Amanda

    • says

      The elbow and wrist pain is an unfortunate consequence of wearing that sling. I would bother the doc about getting rid of the sling early. The total amount of time in the sling is really up to the doc and depends on what his or her protocol is.

      I would also ween off the sling when you get the okay to do so (maybe over several days). You can try walking short distances without the sling, but if the shoulder gets sore I would still wear it for longer bouts of walking.

  4. Ricky says

    Hi Dan,

    Had my first physiotherapy appointment today and not much to be said. Just to remind you I had a paralabral cyst removed and a anterior labrum repair (3 anchors).

    I have a few questions, when it says on websites or papers provided for post op labrum rapier patients that you can’t do certain things until however many weeks post op, for instance, it says that at 12 weeks you will be able to lift your arm overhead, my question is, is this a “you shouldn’t lift your arm above shoulder height because it could damage the rapair or you won’t be able to until around 12 weeks? Basically, is it that shouldn’t be doing it or I won’t be able to do it due to pain and stiffness? My physiotherapist today told me it’s purely capability and that it would take a lot to damage the rapair and he emphasised “a lot” he said it would take full on blunt impact or falling from great height onto the operated shoulder to damage the rapair and doing simple things like using my operated arm to have a shave wouldn’t do any damage to the repair, is this in your opinion true? I’m 17 days post op, how easy or hard is it to damage the repair?

    I’ve been told to just continue with pendulum exercises and was told it isn’t essential to create the movements passively. I mentioned to my physiotherapist that I find myself actively creating the backwards and forwards, side to side and circular motions actively and he said that it was fine and rocking my body wasn’t essential, your opinion? Also I have to do the hand, wrist and elbow exercises whilst I’m wearing the sling.

    I’ve been sleeping without the sling my physiotherapist was happy with that also. Hell I’m game with his relaxed approach because too much stuff to worry over gets my anxiety going but I just wanted another opinion. What would you recommend to a 26 yo lad who’s had my surgery and is 17 days post op?

    I really want to be ahead of schedule in 4 weeks time as I’m off abroad and don’t want my shoulder surgery to be too much of an issue, I’d love to be able to get dressed perhaps not without any pain but more the worry that certain movements could damage the repair, specifically putting my t shirts and polo shirts on, I expect there to be pain and stiffness but will it be normal or a sign I shouldn’t be doing the activity, I’d like to blow dry and style my hair in the evening as well which will mean holding a brush in my operated arm (right arm also dominant arm) and hairdryer in my left arm to style, should this be avoided or will it just be hard to do because of pain and stiffness? At this point I will have been out of the sling for a week and it will be nearly 7 weeks post op, I’m coming out the sling 5 weeks and 2 days post op and going abroad exactly 7 days later. Anyway, I’ve gone on a bit lol.

    Best wishes,

    Ricky.

    • says

      The 12 week arm overhead is more of a timeline of when you should be capable of doing that. having said that however, I would not try to lift your arm overhead until at least 8 weeks, because there is a danger of damaging the shoulder early on.

      Shaving should not ruin your surgery. It takes about 4-6 weeks for the anchors to heal into place. Keep that in mind.

      In terms of the sling, I would recommend sticking to the doc’s protocol.

      In terms of the hair thing, play it by ear. If you can do it with only some stiffness and without sharp pain that is great. I would not push through anything sharp. Wait and see. You will survive.

      • Ricky says

        Hi Dan,

        Thank you for getting back to me, it’s much appreciated.

        So I’m 18 days post op, at this stage what would you have a patient of yours doing exercise wise? At the 6 week mark when I’m out of this sling my PT said he’d give me different exercises to do as I’m only doing pendulum exercises for my shoulder and the normal hand, wrist and elbow exercises to combat an possible stiffness as a result of wearing a sling. Is this where you’d have a patient of yours be at this stage?

        I can’t wait to get rid of this sling but I’m also feeling really anxious it’s making my already asymmetric shoulders more asymmetrical.

        I didn’t think that I’d be doing PT at all post op let alone months. It’s a catch 22 for me, PT could help me realign my shoulders but it also places a tonne of focus on my shoulders which causes me a great deal of anxiety as a result of suffering with body dysmorphic disorder. I’m doomed if I do and I’m doomed if I don’t. I think one day I will be able to commit and engage properly in PT but at the moment I’m finding it really hard because my anxiety is very far from under control.

        How long does PT last post op? When will I be able to just not worry about doing daily exercises?

        Best wishes,

        Ricky.

        • says

          The exercises are typically very boring for the 1st month. Pendulums, passive ranges and such. I also have them do some sliding of the hand on the table with the other arm on top guiding it.

          Pt can last anywhere from 2-5 months post op, depending on how everything is going. You can stop worrying about exercises when you have no pain, normal motions, and you can do everything that you want to do. Even then I would still probably do some gym exercises from time to time to maintain.

  5. Fred says

    background:
    im early 40s and had rotator cuff and SLAP repair surgery with 2 anchors in early July. this is my first surgery so i have no comparison or context for progress/pain, etc. my doc told me to stop wearing the sling after 10 days (except to sleep – i am still wearing it to bed) and started PT 6 days after surgery – formal PT 2x a week and doing it on my own twice a day since i started 6 days after surgery.
    pt on my own or with therapist include: (1) pendulum, 2) rom flexion w/ wiffle-ball bat, 3)scap retraction, 4) standing ext rot cuff stretch behind back, 5) supine ext rot cuff stretch with wiffleball bat. today marks the beginning of week 4 after surgery and i have achieved greater flexibility and no major pain – although at night my shoulder does begin to throb (mainly from muscle tightness and cramping).

    i have talked with 2 people who had the same surgery who said they were in sling for 6 weeks with very limited PT. i want to get ahead of the curve but also dont want to jeopardize long-term health. let my doc know and he and therapist have been proactive about getting out of the sling quickly and pushing (not too hard) my PT.

    question: do i still need to be concerned that the anchors will not set, or can i continue this path?

    • says

      Fred it usually takes 6 weeks for the anchors to heal in to place. Use that as a guide in terms of working the shoulder. According to this timeline you still do need to be a bit careful. You definitely should not be doing any strengthening yet.

      It might be a good idea to get a written timeline / protocol from either the doc or the PT.

  6. Ricky says

    Hi Dan,

    Me again. I’m 5 weeks 1 day post anterior labrum repair, 3 anchors in total. If you remember I also suffer with anxiety and since the surgery I’ve been all over the place, freaking out about if I’m doing exercises correctly, if I’m not doing them enough, if I’m being to aggressive when doing them, like swinging my arm too much during pendulums. I’m coming out my sling on Friday, 2 days away.

    I have a few questions I hope you wouldn’t mind answering. Firstly, I usually only manage to do my exercises twice daily, just pendulums and external rotation to just past neutral, is only twice a day good enough as its all I can fit in? Secondly, I have on occasion woke up laying on my side (my operated shoulder) and become extremely anxious not because of any pain but just the pure fact I’m worried I might of damaged something by laying on it, this happened this morning, I woke up was laying on my operated shoulder, on my side, no pain at all but my anxiety took hold and I started to freak out, is it safe for me to lay on my side/operated shoulder? Do I have nothing to worry about now that I’m 5 weeks 1 day post op and little to no pain? Third question, are popping and cracking sounds normal when doing pendulums? It’s not happening every time I do them but when it does I’m wondering if I’m doing something wrong or if I’ve damaged the repair somehow or if I’m being too vigorous and swinging my arm too much, is it possible to damage anything doing pendulums? Does no pain mean everything is healing properly? My fourth question is, how much longer are pendulums a necessary exercise, I see my PT for the second time Friday and hope that I can scrap pendulums, they’re becoming boring and don’t feel like they’re doing much at all anymore, ideally I wish I didn’t have to do anymore exercises at all but I know it’s mandatory, I just hope that I’ll have a fresh exercise plan that doesn’t include pendulums because I’ve done them soley for over 5 weeks.

    I really need some peace of mind, since the op I’ve barely used my right arm except for washing and exercises, I stopped wearing the sling in bed after 7-10 days but have been extremely strict and slept on my back, I’d say from week 4 onwards I started laying on my side, my non operated arm on occasion since it it no longer made my operated shoulder ache but still I tried to stick to laying on my back as much as possible, over the last 3-5 days I’ve accidentally laid on my operated side on occasion without thinking, probably because I’m half asleep and it doesn’t hurt at all to lay on it, am I technically safe to lay on it in bed now? Lastly, would I know if something wasn’t right with the operated shoulder? Would I know if I damaged the repair? Would it hurt a lot? Would it take a lot to damage a anterior labrum repair? Ive been extra safe but am still ultra paranoid as I don’t want to go back under the knife, I already regret having the surgery because of all the hassle it’s caused.

    Sorry for the long message, I hope you can find the time to answer all my questions.

    Kind regards,

    Ricky

    • says

      If you are not having pain with the sleeping positions, I wouldn’t worry about it. It sounds like things are going well. I would in general try not to sleep on the surgical side, but if it doesn’t hurt, you are probably fine.

      Stick to the PT’s advice in terms of exercise frequency. It would be really difficult to damage the arm doing pendulum exercises at this stage.

      You should also run these questions by your doc and PT Ricky. I am happy to tell you what I think, but realize that I have never seen your shoulder.

  7. Jeff says

    Hi Dan I had rotator cuff surgery on July 22 and came home the same day. Now its Aug 1st and I am down to one diluadid and 1 Tylenol. I go for physio on Tuesday startibg with pendulum swings. Does having Spina Bifida make it take longer in a sling than 4-6 wks cause I use my arms so much or not. Im a little weary of the first time with sling off cause my mind is already playing tricks on me. Thanks, Jeff

    • says

      Jeff I don’t think that I have ever treated someone with spina bifida for a post-op RC surgery. I would guess that it might slow down the rehab time slightly. Get a direct answer from the doc about this. I am a believer in weaning yourself off the sling a bit at a time, so I start with it off while you are sitting and not doing much. The shoulder needs to acclimate to a more normal position.

  8. Ricky says

    Hi Dan,

    I started some new exercises, one being crawling my arm up the wall as high as I can. I did it today and really pushed myself, I think a bit too much. I’m 2 days away from being 6 weeks post op, anterior labrum repair (3 anchors) I feel today, when I crawled my arm up the wall I pushed myself a tad too much and I’m worried I may have damaged something, I’m sure I heard a strange sound when what I deemed was an over reach whilst crawling my arm up the wall. Would pushing myself a bit too much and crawling too high cause damage or is it unlikely 6 weeks post op? From what I’ve heard, once those anchors are in place, it will take a tremendous force to dislodge them and ruin the repair? What’s your opinion?

    • says

      Just crawling up the wall, highly unlikely that you tore something. You would have to do something requiring a lot more force. Don’t sweat it. give a few days to rest and talk to the doc if necessary.

      Your questions are getting shorter Ricky, this must mean that you are improving! Congrats.

      • Ricky says

        Hi Dan

        I can’t thank you enough for your prompt replies. It’s not easy getting hold of my orthopaedic surgeon, the NHS here in England is extremely busy and I can’t just request an appointment with him, nor can I even get him on the phone, he works a private practice and for the NHS so he’s not got the time, my next appointment is September 11th, I have PT again in 3 weeks, a few days after my return from Turkey. Your my best source for reassurance and info if I’m honest.

        So even crawling up the wall and really reaching high, maybe pushing a tad beyond comfortable isn’t likely to have caused any damage to the repair? I’ve gone from pendulums for 5 and half weeks, straight to more intense/active exercises. I expect pain a tightness with these new exercises as it’s still early days but I’m worried I won’t know the difference between normal and acceptable pain and “oh shit, did I push myself too much?”

        Is it highly likely the labrum is now healed in place and highly unlikely instructed PT exercises, even if pushed a bit too hard at times would re tear it? I’ve heard that a labrum held in by anchors is stronger than a perfectly healthy one, true?

        Regards,

        Ricky.

        • says

          I highly doubt that pushing the end range of the wall crawls re-tore the anchor. I wouldn’t go doing that all of the time because it may inflame it.

          Will the anchor heal stronger than before, I am not so sure about that. I think that you are referring to bone / fracture healing.

          • Ricky says

            Hi Dan,

            Again, thank you for your response. It’s me all over, trying to push things to the limit when doing exercises. I don’t know why I did really reach up high whilst crawling the wall with my op arm, I had it basically completely vertical. The sheet says to climb the arm as high as possible but I’m still scared I pushed myself a bit to much. I’ve been so protective of my op arm and to do something silly like that has really freaked me out. I don’t want to go back under the knife again and really hope that all is well with my op shoulder. So just for clarification, you don’t think that a wall crawl, even if I went a tad beyond comfortable range could re-injure a anterior labrum repair (3 anchors) at basically 6 weeks post op? Also, how would I know if I had injured something? And, what sort of things could re-injure a anterior labrum repair at this stage in recovery?

            Cheers,

            Ricky.

  9. Ricky says

    Hi Dan,

    I know I’m only 3 days out of my sling and I imagine that some of the pain I’m in today is just being out of the sling but I’m still really worried I’ve done something bad during yesterday’s wall crawl. My PT didn’t explain the exercises I’ve been instructed to do well enough. I crawled my arm as high was even a non op arm would go. I had my chest against the wall and reached high so high even my upper trapezius took over to elevate the shoulder. I’m really concerned I’ve damaged something. I know I’ve asked already but do you think I’ve just strained something and over did it during the wall crawl or is it possible I’ve damaged something because I’m sitting in my computer chair, both arm relaxed but my shoulder is really aching.

    • says

      It is going to ache, especially since your activity level has been increased. If you are that concerned about it you can always ask the doc about it.

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