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.

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