April 17, 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. Hello,

    I had surgery on December 27th. I had a slap tear, and bursitis; the doctor had me on a sling for four weeks. I have done some of the things that you suggest on your article, but I just stopped using the sling, and my arm is killing me. I can’t walk without experiencing some kind of pain. Sleeping has been even worse; So I have started to take my pain medication again.

    I am concern because it’s been four weeks and I haven’t had physical therapy (only on my own).

    Is it normal to be in pain after you stop using the sling?

    • Yes it is normal to have some pain after a decreased usage of the sling. I would recommend “weening” off the sling a little bit at a time, it sounds like your weak shoulder is having a tough time accommodating to a slight arm swing.

      It is of course a good idea to let the doctor know what is going on.

  2. Hello, I had Arthrosopic Labral Repair surgery on the 23rd of December 2013 and have weened off the sling gradually over time and have discontinued use as of the 6th of February 2014. I was just wondering what sort of indicators a patient would receive if they had damaged or ruined the labral repair and if it is possible to ruin the repair and not know? There has only been once incident of concern and i had minimal pain but i am very eager to have the best possible recovery and want to make sure i haven’t jeopardized the recovery process. I have no pain in my shoulder at all when doing any physical therapy or throughout my daily routine and the shoulders feels as if it is healing well and movement is slowly coming back although i am being very careful not to over do it. Thanks for responding in advance.

  3. Hi,
    I had a labral repair on my left shoulder on the 21st of January. Although my recovery has been progressing, i have noticed a discernible drooping of my left shoulder. It is about 2-3 inches lower than my right shoulder. Is this normal?

    • I am guessing that this was not noticeable before the surgery? The most likely explanation is that your upper trapezium, or shoulder “shrugging” muscle is a bit weak from underuse. A shoulder sling can also encourage this positioning. It should come back once you are cleared to start working the muscles.

      Run it by the doctor to be sure.

  4. Hello,
    I had an 80% cuff tear and bone spur removal on Jan. 8th. I wore the sling at all times for about the first 2 weeks. However at my initial follow up, I was instructed that the sling only really needed to be worn to prevent large arm motions (raising arm upwards, pushing self up with arm, etc) and it was OK to not have it on when in a sound environment like at home. Since I was almost exclusively at home for 3.5 weeks, I rarely wore the sling. I would wear it when leaving the house/out in public only. I was then instructed it was safe to return to work, which is a sedentary desk job. That said, at this point I am approaching 5 weeks post-op, and have barely worn the sling. Again, except when in public or uncontrolled environments. All my arm motions have been limited to arm at side, elbow only extending away about as far as it would to pull up ones pants. In fact, the biggest flare I had was when I was wearing the sling, and the ice pack on my shoulder started to slide off… I motioned as if to grab it with the slinged arm. Didn’t feel so great, to put it mildly. Anywho, here I sit, as I said 5 weeks out, sling barely used except when in public, which has been at an absolute minimum. My question is, am I totally fubar’d here, or what? Everything I read says folks should be in-sling almost all the time. I was pretty much the opposite. I did feel as though I was following Dr’s orders, as the sling was worn when in uncontrolled environments, and I definitely did not have any issues forgetting about the procedure and doing jumping jacks, or anything of that nature. Would love to hear your thoughts. Thanks!

    Andy

    • Andy I would not worry about it. The sling’s purpose is to keep people from doing stupid things with the surgical arm. It sounds like you did not do anything stupid.

      Follow your rehab protocols and you should slowly return to normal function. Carry on!

      • Thank you for the feedback! To this point it seems my biggest challenge, at least in the PT activities, is muscle guarding. It’s been very tough to just let the arm be loose. Not sure how to get past that part of things. Overall just looking forward to making progress, even if it comes in small steps.

  5. Hi,

    I had a arthoscopic labaral repair and in 2 weeks after i had of my ligment repaired i have tooken off my sling a couple times during my sleep or going to school. I bearly do any exercise or sports and i was told by my doctor it was a small tear. I just wanted to ask if It was okay to have the sling off even though i dont move my shoulder or arm around as much? When I do move my shoulder or arm it doesnt cause any pain. When I first took my sling off it was a bit sore but after that it doesnt hurt much.

    • Hazey you should stick to your doctor’s recommendations particularly for the first month. The anchor that the doctor used to secure your labrum into place needs a good 4-6 weeks to heal into place. The sling is a necessary evil for this reason. A sudden forceful movement of the arm could jar it loose.

      If you are sitting quietly it would probably be fine to take your sling off, but you really need to wear it when you sleep and when you are moving around. But if the doctor tells you to wear it at all times, then that is what you should do.

  6. Hi

    I am having a SLAP tear repair (four small incisions) soon as three months of physical therapy have not alleviated original pain. I have good range of motion and caught it early I think. I am worried about sleeping. I have a back injury that is relieved when lying down with zero to slight ( 30 degree) recline. Any deeper recline is difficult on my back so unable to elevate beyond that. Will I be able to sleep in an adjustable temper pedic bed elevated with pillow props successfully ? I don’t own a recliner of any kind with the bed being the only option. Thank you so much for your advice ahead of time.

    • A reclining bed is really ideal for the surgery that you are having. You should be able to handle it with a little bit of incline. I would also place a pillow under the elbow and across your stomach, with your arm resting on top of the pillow (I have a photo in one of those shoulder blogs). Don’t stress about it, that should help.

  7. janae linder says:

    I’m scheduled to have my 3rd shoulder scope surgery in 14 months. I’ve been told that I have a torn labrum and torn rotator cuff tears. But I’ve been in horrible agony for the past 3 months and nothing’s worked for me so far. What should I expect with a possible rotator cuff repair? Here’s what sucks, I can’t stomach pain killers at all and I don’t want another block since the 1st 2 caused me more problems.

    • That does not sound like fun Janae. If the surgeon is going to repair both issues at the same time, the rehab will probably be at least six months, maybe longer. Try to figure out with the doc if there is any other option in terms of pain control during the early phases.

      You basically cannot move your arm actively for at least the first four to six weeks after rotator cuff surgery. Strengthening usually does not begin until 10-12 weeks after the surgery. Be patient. Stick to the doctor and the PT’s protocols even if they bore you to death.

  8. Hi There,

    I am 7 days post op from a arthroscopic shoulder repair for dislocation which included a remplissage procedure. I was told I have 5 anchors in place now in my shoulder. Last night perhaps due to painkillers as you mentioned in an earlier post I had a dream that caused swat at my ear thinking there was a spider and I did so of course with my repaired arm. I was wearing a sling at the time but it was certainly a fast jerk type response and woke me straight away with sharp pain. My shoulder didn’t move very far at all, the arm wasn’t flailing around and i’d say most of the motion was from my elbow down but I’m concerned now about the potential of having done damage to the repair. The pain went away immediately after the incident but I wonder if I need to be concerned or wonder what symptoms would be reason to consult my doctor on this and what potential next steps would be considered if any.

    Thanks in advance for your thoughts..

    • Jason it does not sound like you placed enough torque to jar those anchors loose. What I would expect is for the shoulder to be very sore for a while. If you did tear an anchor it would likely be manifested with sharp, unrelenting pain.

      I would ice it a bit and take it easy. Let your PT and / or doctor know what is going on.

      • Thanks Dan,

        I appreciate you taking the time to get back to me, very kind of you. I’m not having any sharp unrelenting pain so I guess I’m in the clear. Due to my procedure I’m not due to begin any PT for a full month so I have a few weeks to go in the sling. If you have a suggestion of someone in NYC I should see for PT I would certainly try to follow up with them. I am an avid ww kayaker and want to have the most successful return to paddling I can so I plan to take my PT very seriously..

        Thanks Again,

        Jason

  9. Hi. Happy to have found this site. I had SLAP (type 3) and bone spur removal on 3-18 (from 10-31-13 fall down stairs at work). Had been going to his P/T since for various sprains and cervical herniated discs. Did well there and was left with tear to deal with. Surgeon is excellent, office support not so much. Tons of anxiety leading up to workman’s comp authorization because they sent request 7 wks ahead to car insurance. Had overlapping car accident, kept telling me there was “plenty of time” so never followed up until week before. W/C ended up doing urgent 1-day approval Friday before Tuesday surgery. Anyway…

    My husband swears Dr. told him while I was in recovery to take arm out of sling late next day and just very gently be sure I could extend elbow. There was no written instruction. Hospital discharge just said wear sling, remove nerve block when empty after 3 days, remove dressing, clean cath site with betadine and bandaid every day.

    Extended elbow that one time then called Dr. office. Nurse said remove ALL dressing and clean as above, DO NOT remove arm from sling at all. Had to ask about steri-tapes. Couldn’t believe lack of specific instructions. Like I’m supposed to know! Had to call and ask about thick pad in underarm – was it just part of dressing or needed for “spacing” of some sort. Never called me back. Decided to replace regularly to help with sweatiness. One steri-tape came off with bandaid, but looks fine. 3 incisions front (tear), 2 back (spur).

    Despite tons of conflicting internet info, I decided everybody’s surgery is different and keep arm in sling. Especially showering info. Use complicated trash bag system to keep sling and stitches dry. Only slipped out twice by accident while sleeping – woke to find arm bent in sling position and no pain, hand on stomach, and once slow and deliberate to blow nose properly. Dr. told me weeks before I’d be able to type right away, but that conflicts with no out of sling time, so had boss buy dictation software and muddling through with left hand (I’m right-handed). Figure better safe than sorry.

    Getting stitches out 4-2. Nerve block caused shortness of breath (anesthesiologist called next day as well as hospital to follow up). Not gasping, but could only say a few words at a time without breathing. Anesthesiologist block affects diaphragm and was OK. Called my pulmonary Dr. (sleep apnea plus tracheomalacia) to be sure was true and used my CPAP all day. Didn’t like cath removal instructions of “just gently pull it out” so Googled that too. Glad I saw parts about looking for black marks to be sure it all came out. Made me feel better that all was right. Anyway again…

    Don’t take oxycodone except at night – have to stay awake to work. Pain is moderate and intermittent – very occasional burning sensation where tear and spur were and at incisions. Not really any swelling at all. Deltoid feels like sore muscle occasionally especially when jockeying for sleeping position. Had constant “burning deltoid” from fall to surgery. Worst is coccyx pain from fall exacerbated by constant sitting or lying down. That and that chiro can’t treat my crooked pelvis until shoulder is more healed. She treats my neck very gently (pre-existing neck, pelvis plus car accident), but coccyx combined with pre-existing and fall – everything is lopsided down to foot pain from that – so hard to get comfortable.

    All-in-all, with co-existing conditions, I THINK I’m coming along as expected. Think I may blog about “little crap no one tells you” when all is said and done. Actually looking forward to post-op P/T despite pre- 18 sessions for fall just to be moving arm slightly! Won’t find out until 4-2 when P/T will start. Anything sound out of place to you? Thanks for listening and for your posted info.

    • P.S. Nurse did say wriggle fingers/wrist a few times a day (inside sling). Had to look up whether fingers should extend from sling too – internet pics showed that a lot! and mine didn’t – but found site that said no. That would mean arm is being pulled across body and maybe wrong elbow angle in sling – should be 90 degrees bend.

    • Wow, that is a lot of information Kathy. The “thick pad” in the underarm is something that some surgeons might use, although from my experience it is not common. The nerve block thing sounded absolutely awful.

      The worst is over, congrats. When you start PT, stick to the protocol that the doc gives you and everything should slowly come back.

      • Sorry, I tend to be very wordy. LOL! So basically, everything seems right to you? 1. Types of pain I’m having (mostly that pulled-muscle deltoid sort), 2) keeping arm in sling at all times even for showering despite what websites say, 3) fingers not extending past end of sling, etc.? 4) Was it a mistake to extend arm that one time? As I said, ambiguous and/or unwritten instructions. If I were to have damaged the repair, I’d have lots of pain, right? I’ve only had carpal tunnel surgery about 25 years ago, hence my “nervous Nilly-ness.”

  10. I had a rotator cuff arthroscopic surgery to take care of a slap, rotator tear and removing a 14mm cyst. I am now 9 days post op and feel incredible. The cyst was causing nerve damage and not firing the 2 muscles in my back adjacent to my shoulder. I get little pins and needles feelings in those muscle right now and have so much pain free range of motion in my shoulder that I am worried I am going to mess up what’s been done. I was a pretty heavy weight lifter, but have been out of the gym for almost a year due to job responsibilities. Should I be worried when I take my sling off and have a wide range of motion w/o pain that I am going to damage all the good that has been done? I don’t see my Dr. for another week and was told I would be in the sling for six weeks, but at this point I almost see no reason in wearing it… Any input is appreciated and I think it’s great that you take time out of your schedule to respond to people in here! Thanks in advance!

    • Wear the sling in public and when you sleep (at least). You don’t need people bumping in to you and some people do thrash a bit when sleeping. Remember Jeremy that it takes a good 4-6 weeks for the anchors to heal down in to the tissue, so even though you feel a good amount of relief there is risk involved with active motions early on. Better to be safe than sorry! Stick to the MD’s protocols.

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