September 3, 2014

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.

About Dan Baumstark, MSPT, CHT

Dan is a physical therapist who specializes in sports medicine & upper extremity rehabilitation. He is certified by the American Society of Hand Therapists, and he has extensive continuing education in manual therapy from the Michigan State University School of Osteopathic Medicine. Google+

Comments

  1. James Eckert says:

    Hi,

    I’m a 63-year-old male. I had a complete tear of one of the rotator cuff tendons while lifting a bicycle high overhead and forcing it onto a bicycle rack.

    During the rotator cuff surgery, the surgeon also did some work and repair on the tendon from the bicep to the rotator cuff. How common is this?

    Jim

    • That type of injury is more common than you may think. Our tendons lose a bit of vascularity as we age, so sometimes with heavy overhead motions the supraspinatus tendon in particular is a bit vulnerable. The long head of the biceps attaches right next to the supraspinatus, so one injury often piggy backs on the other.

  2. Deanna Schmidt says:

    I’m a little past 3 weeks post op for rotator cuff repair and go in for my next follow up on Monday. I’ve been in my sling the entire time and I’m looking forward to the day PT starts, I’m getting antsy being confined!!!

    We have a family vacation planned for mid Aug to a beach resort in Jamaica. In your experience, will I still need to use my sling, and what kind of limitations should I still expect?

    Deanna

    • Deanna I do not think that you will need to be using a sling by then. Your arm may still be a bit weak, so lugging heavy suitcases should be pimped off on your significant other. Use the term “medically necessary”.

      • Deanna Schmidt says:

        Thanks. My husband has been a gem helping me in so many ways since surgery, I’ll have to remember the “medical necessary” response for future use. LOL One other question,
        I’ve been sleeping in a recliner since surgery, in your experience when is one able to return to a normal bed, normal sleeping position?

        Thanks again

  3. michael says:

    Doc, I wear my sling at all times, except when showering and the occasional pendulum exercise; one week post op; can I sleep without it?

    • I would keep it on during the first several weeks. We don’t need you thrashing your arm while you are sleeping. Your doc will usually have a protocol in terms of how long he / she wants you wearing the sling.

  4. Sharon Donald says:

    I dislocated my shoulder had surgery to put it back in place. I haven’t had a good night sleep in four weeks! Any suggestions how to get some sleep at night! The pain comes at night when I ‘m in bed! I’m in a sling and I try sleeping in it!

    • Try propping pillows under the elbow and forearm, I believe that we have a picture of such a position under our “sleeping comfort” article. Your doc should also be able to prescribe you something to help you sleep.

  5. Luke Doty says:

    How much force does it take to undo a labrum repair. I’m 5 days post op and am in the sling of course. My dr told me the repair was done where the biceps tendon attaches to the shoulder. Today, without thinking, I started to Greg a gallon of milk from the table. I was reminded of my injury by some minor pain and stopped immediately. The pain also stopped and I currently have no pain. Do you suppose I ruined the repair and how much does it take to ruin it. I want to do this recovery correctly. And am being more cautious.

    • It takes a fair amount of force to dislodge the anchors that the surgeon used, but it does occasionally happen. If you merely started to grab the milk and didn’t actually go through the entire process of lifting it and moving it, you are most likely fine.

      A sign of tearing the anchors is a huge amount of pain that it constant. It doesn’t sound like what you are describing.

  6. Hi, I just recently had surgery 4 weeks ago today to tighten the tendons/ligaments in my shoulder and woke up in the recovery room in a big, bulky sling they called an immobilizer. I have an appointment to meet up with the doctor that did my surgery in 2 weeks. When we asked how long I have to have the immobilizer on, I was told 6 weeks. I have to be in the immobilizer nonstop unless I am showering, at physical therapy, or changing my clothes. Other than that, I keep it on and don’t use it much as I can keep from. I haven’t taken my pain meds one time post-op and therapist say I am doing well on my range of motion. My question is, when I go back to the doctor in 2 weeks, will they let me out of the immobilizer completely or will they put me in a normal sling? (The padding and straps come off of the sling/immobilizer)

    -Maddi

    • Maddi I am guessing that going off the immobilizer “cold turkey” may be a bit much, both physically and possibly psychologically. The doc might put you in a simple sling and tell you to only wear it during certain times or with certain activities. I would pick your PT’s brain about exercises to start that will help the process be less abrupt. With the docs permission, it is also a great idea to practice some walking with a bit of arm swing.

  7. Damon McDaniel says:

    I had surgery last week and Ive been starting to go without the sling at home and during class (Im a math teacher and I need to be able to write!)

    I have noticed a lot of pectoral soreness after spending most of the day out of my sling. This was something that would occur pre surgery too, so Im a little worried about that. Is it just because of my arm having to compensate for a torn cuff pre surgery and now a healing cuff post surgery? Is this a common complaint that should dissipate as I rehab?

    • Damon if the pectoral soreness is only present when out of the sling, it is probably your body’s reliance on that muscle as a stabilizer for your shoulder. The shoulder tends to go into a forward position when it is perturbed, and the pectoralis is one of the muscles that draws the shoulder forward. It should slowly go away as you get stronger. Stick to the doctors rehab protocol and obviously talk to him / her if the pain intensifies or doesn’t lessen.

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