March 28, 2015

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. Jack Lipp says:

    I just had rotator surgery but I also have Eczema the sling is bothering my arm. Any suggestions

    • Ugh that is a tough one. Check the internet and see if there are any types of slings that are more mesh than solid material. I would also ask the doc if you can spend some time out of the sling every day to let things “air out”.

  2. Approximately 3 weeks ago I had labrum surgery which involved having 8 anchors installed to repair my labrum. I am following doctors orders as part of my recovery, I am curious to know if I do anything to harm my surgery or damage the repair- will I know it? I’m scared that I will screw this recovery up and not know it for along time to come. Thank you

    • Chris you would normally have to do something very abrupt to the shoulder, like fall and try to catch yourself with the surgical side. Anchor tears usually feel like sharp, disproportionate, constant pain.

      Having said that, we see TONS of physical therapy patients here in DC who are post-op that have varying levels of pain that I would consider normal.

  3. I’m having labrum repair surgery this Monday. The pain that is usually over the top of my shoulder and down the front has also started to travel up the right side of my neck and down the back of my arm. Thanks in advance

    • Lance the repair should ultimately help with much of that pain, but I am wondering if the neck pain is more of a postural compensation that you are having because of the shoulder issue. Once this is all said and done, you should have your PT check your posture and spinal alignment to make sure that everything looks good.

  4. Hi Dan Baumstark

    On the 22nd of January I had a arthroscopic right shoulder labrum repair, 3 nearly 4 weeks ago to this day.
    Everything was fine in regards to pain and retaining my movement as of two days ago, when I subconsciously without my sling supported myself to sit down on a bus rail (pole)… whilst resting my shoulder from wearing the sling all day…

    As a result I’m feeling a slight uncomfortable pain, not excruciating but apparent.

    Do you reckon I have damaged the shoulder procedure or just irritated it?

    I would appreciate if you could give me some advise

    Thanks

    Rhys

    • Most likely just irritation. It usually takes more of an abrupt, hard jerking motion to pull anchors. You may feel it for a week or two though. I would back off of the PT exercises for a few days to allow some healing. You can of course always talk to the doc about what happened if you feel that things aren’t going in the right direction.

  5. Hi,
    I had arthroscopic rotator cuff repair six weeks ago tomorrow. I had a surpraspinitus tear sewn up and a biceps tendonesis plus some cleaning up of the labrum. Recovery has been going well and I started passive PT last week, with all feeling good. Then yesterday — while wearing the sling — I reflexively pulled my operative arm back after touching something burning hot. It was definitely a jerking motion and I have been sore since then. I’m heartsick to think I might have re-torn something or dislodged anchors. I am feeling a bit of burning sensation. I have another PT appointment tomorrow. Should I lay off for a bit? Please tell me it just needs a little rest and some ice . . .
    Thanks.

    • Tell the PT what happened. At six weeks that repairs are probably fine. The most likely scenario is that you inflamed the tissue a bit from the sudden motion. I would take it easy for a few more days and if it is not getting better I would talk to the doc about it.

  6. Hello I had labrum surgery 2 weeks and 3 days ago it is feeling pretty good and already have a lot of motion back. Do you think it would be safe to sleep without the sling. I’ve slept In a recliner all but two days since surgery and when i try to sleep in my bed I just can’t get comfy with this awful sling on.

  7. I had labrum repair surgery on February 20, about 16 days ago. I had a tear from about 3 PM to 9 PM, requiring about six anchors. I took two weeks off work, meaning I didn’t go into the office, however I did work from home on my laptop. By day 12 post-op, I took the sling off only when I was lying propped up in bed on the computer. By 14 days post-op, I’ve been keeping it off pretty much all the time because I can’t stand it and it gives me a rash and hurts my neck. I mostly try not to use my right arm, but have accidentally done so a few times causing some pretty jarring pain, but it usually goes away within 10 minutes. I went in 10 days postop and surgeon said I did not have to wear the sling all the time but that I should wear it “walking around and when standing” to support the shoulder, and that I only needed to use it for about two more weeks. The shoulder feels fine if I just keep my hand in a hoodie pocket and don’t use it. My question is how do I know if I’ve re-injured it? For example, my elbow hit the knob in the shower making the water really hot, and by instinct I shot out my right arm to turn it down and then felt like it was going to fall off. It throbbed for about an hour after that but got better after I iced it. I’ve done something similar a few times since then, causing acute pain that usually went away within the hour. I can’t reach behind me at all, or have my arm reach out to the side, but sometimes I forget and then my shoulder reminds me. Am I causing damage? Should I suck up the rash and the neck pain and just wear the sling?

    • Usually when an anchor has pulled, there is disproportionate pain that is constant in nature. They things that you described do not sound like they would dislodge an anchor, although it certainly can increase the overall inflammation of the shoulder.

      If the doc said that it is okay to ditch the sling, then it is up to you. If you feel that wearing the sling prevents sudden movements of the arm then it might be of use to you.

  8. Hello. I had labrum surgery on my left shoulder, 4 anchors. At 2 weeks post op i fell with my sling on. I know im being paranoid thinking i have damaged something. I didnt have any pain when i fell and i still dont have any pain from the fall. I guess my question is, if i were to have damaged my surgery wouldnt i be in a pretty good amount of pain? I wouldnt think i could wreck the surgery without having a intense amount of pain. thanks and sorry for the paranomia,

  9. I just had rotator cuff surgery a little over 5 weeks ago. My doc says its ok to have my sling off off and on during the day. Well I had my sling off an accidentally picked up a small cereal sized bowl with my repaired arm and then I quickly realized what I was doing and put it down. I didn’t feel any pain at all, but I am worried I could have ruined the surgery. Am i just being paranoid?

    • I also wanted to add that when I have been sleeping my shoulder has twitched/shivered/spasmed and it popped and one time it actually woke me up cause it hurt. Should i be worried about that or is that normal?

    • Highly unlikely that lifting a cereal bowl would dislodge your surgery at five weeks.

      I would not sleep on the surgical shoulder if you can all avoid it.

  10. I had labrum repair 3 weeks ago. The other night I was getting ready for bed and rolled to far over onto my slinged arm. It felt like a rubber band breaking and the next day was followed with pain that i have not felt since the surgery. Is this something I should worry about or just irritation?

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