Is an arm sling indicated for elbow injuries?

Arm Sling Use for Elbow Injuries

Arm slings are generally not indicated as the primary treatment for most elbow injuries, as early mobilization is preferred to prevent elbow stiffness and limited joint mobility. 1, 2

Assessment of Elbow Injuries

When evaluating elbow injuries, consider:

• Mechanism of injury (direct blow vs. fall on outstretched hand)
• Physical examination findings:
  • Visible deformity, ecchymosis, asymmetry
  • Palpation for tenderness and instability
  • Range of motion and strength testing
  • Specific provocative tests for tendon integrity 3

Imaging Approach

For acute elbow pain:

1. Plain radiographs (X-rays) are the first-line imaging modality 1, 3
2. If radiographs are normal or indeterminate:
   • For suspected fracture: Repeat radiographs in 10-14 days or CT without contrast 1
   • For suspected tendon/ligament injury: Ultrasound or MRI without contrast 1, 3

Treatment Recommendations Based on Injury Type

Fractures and Dislocations

• Primary goal: Achieve anatomic reduction while allowing for early range of motion 2
• Immobilization considerations:
  • Brief immobilization may be necessary immediately after reduction
  • Prolonged immobilization should be avoided to prevent elbow stiffness 2, 4
  • "The dogma stating that the elbow should never be immobilized remains valid" 4

Tendon Injuries

• Partial tears: Conservative management with:
  • Rest
  • Limited immobilization (not necessarily a sling)
  • Elevation
  • Analgesics 3
• Complete tears: Early surgical intervention typically provides better outcomes 3

Ligamentous Injuries

• For instability after dislocation: Consider ligament repair and possibly a hinged external fixator to allow early mobilization 4

Rehabilitation Approach

• Begin gradual progressive strengthening exercises after 1-2 weeks
• Start range of motion exercises early to prevent stiffness
• Consider supervised physical therapy for optimal functional outcomes 3

Important Caveats

• Avoid overhead pulley exercises in patients with shoulder pain following stroke (this may apply to other upper extremity injuries as well) 1
• When positioning patients during procedures, limit arm abduction to 90° in supine patients to decrease risk of brachial plexus neuropathy 1
• Watch for signs of compartment syndrome (pain out of proportion to injury, pain with passive stretching, paresthesia, pallor, pulselessness) 3

Conclusion

While arm slings may provide temporary comfort for certain elbow injuries, they should not be used for prolonged periods as they can contribute to joint stiffness and limited mobility. The focus should be on early, controlled mobilization to optimize functional outcomes while providing adequate pain control.