When is an arm sling indicated?

Indications for Arm Sling Use

Arm slings are indicated for shoulder subluxation after stroke, clavicle fractures, proximal humerus fractures, post-operative shoulder stabilization, and as temporary support for acute limb trauma with active bleeding when direct compression is ineffective. 1, 2, 3

Specific Clinical Indications

Stroke-Related Indications

• Shoulder subluxation in stroke patients
  • Slings can help reduce shoulder subluxation in the acute phase of stroke 2
  • For people in wheelchairs, lap trays and arm troughs may be useful positioning devices to reduce shoulder pain and subluxation 2
  • Use during ambulation training to protect the shoulder from traction injury 2

Trauma-Related Indications

• Clavicle fractures

  • Simple arm sling is preferable to figure-of-eight bandage for mid-shaft clavicle fractures
  • Provides better pain control (lower VAS pain scores) and easier application 3

• Proximal humerus fractures

  • Indicated for most proximal humerus fractures that can be managed non-operatively
  • Should be used with early range-of-motion exercises and strength training 4

• Severe limb trauma with bleeding

  • When direct compression is ineffective for active limb hemorrhage
  • In cases of amputation or foreign body within hemorrhagic wound
  • When patient lacks radial pulse (hemodynamic compromise)
  • When multiple simultaneous actions need to be performed 2

Contraindications and Cautions

• Anterior shoulder dislocations

  • Traditional sling use (internal rotation position) may worsen detachment of anterior shoulder structures
  • External rotation positioning may be more appropriate 5

• Hemiplegic shoulder pain

  • Slings may inhibit active correction of subluxation
  • Some evidence suggests patients without slings may have better reduction in subluxation over time 6
  • Avoid overhead pulley exercises in these patients 2

Duration of Use and Monitoring

• Reassessment is crucial

  • If a tourniquet or sling is applied for trauma, re-evaluate its effectiveness, usefulness, and location as soon as possible 2
  • For fractures, limit each application to periods of 20 minutes to prevent cold injury 2

• Rehabilitation considerations

  • Early finger motion is essential after distal radius fracture casting to prevent edema and stiffness
  • For shoulder injuries, range-of-motion exercises including shoulder, elbow, wrist, and hand motion should begin within the first postoperative days
  • A sling is usually worn for comfort only and may be discarded as early as the patient's pain allows 2

Practical Application Tips

• For shoulder injuries, initial physical therapy should focus on:

  • Pain control measures
  • Gentle range of motion exercises
  • Proper positioning education
  • Isometric exercises for muscle reactivation if no pain is present 1

• For fractures:

  • Do not move or try to straighten an injured extremity
  • If far from definitive healthcare, stabilize the extremity with a splint in the position found
  • If a splint is used, it should be padded to cushion the injury 2

Evidence Quality Considerations

The evidence for arm sling use varies by condition. The strongest evidence supports sling use for fractures and acute trauma, while evidence for stroke-related shoulder subluxation is more mixed. Recent research suggests that some patients with stroke-related subluxation may benefit more from active correction without a sling 6, but slings remain indicated during specific activities like ambulation training 2.

Remember that proper positioning and early, appropriate rehabilitation are often more important than the sling itself for long-term outcomes and quality of life.