When can I discontinue using a pillow with a rotator cuff repair (rotator cuff injury) sling?

When to Discontinue the Abduction Pillow After Rotator Cuff Repair

You can safely discontinue the abduction pillow at 3 weeks after rotator cuff repair for small to medium tears, or even consider not using a sling at all, as immobilization beyond this timeframe provides no additional benefit and may delay functional recovery.

Evidence Against Prolonged Immobilization

The American Academy of Orthopaedic Surgeons guidelines explicitly state they "cannot recommend for or against the preferential use of an abduction pillow versus a standard sling after rotator cuff repair" due to insufficient clinical data demonstrating any advantage of the pillow 1. More importantly, no clinical data supports that a sling, shoulder immobilizer, abduction pillow, or abduction brace improves tendon healing or outcomes 1.

Optimal Immobilization Duration

3 Weeks is Non-Inferior to 6 Weeks

• A high-quality randomized controlled trial (Level I evidence) demonstrated that 3 weeks of simple sling immobilization was non-inferior to 6 weeks of immobilization with an abduction pillow brace for small to medium rotator cuff tears 2
• Both groups showed similar WORC index scores (83% vs 87%), age-adjusted Constant-Murley scores (86 vs 90), and MRI healing rates (89% in both groups) at 1 year 2
• The 3-week group used only a simple sling, while the 6-week group used a brace with abduction pillow—yet outcomes were equivalent 2

Consider No Sling at All

• An even more recent Level I randomized trial found that patients who used no sling after rotator cuff repair had better early mobility and functional outcomes compared to those immobilized in a sling for 4-6 weeks 3
• The no-sling group showed significantly better external rotation (23.5° vs 15.3°) and active elevation (110.9° vs 97.0°) at 6 weeks, and better active elevation (139.0° vs 125.8°) and internal rotation at 3 months 3
• Ultrasound at 6 months revealed no differences in repair integrity between groups 3
• Multivariable analysis confirmed that sling immobilization was associated with worse SANE scores and increased pain 3

Practical Algorithm

For small to medium rotator cuff tears:

1. Weeks 0-3: Use simple sling for comfort only (not mandatory); begin passive range of motion immediately 3, 2
2. Week 3: Discontinue abduction pillow if used; transition to simple sling or no immobilization 2
3. Weeks 3-6: Continue passive range of motion exercises 2
4. Week 6: Remove all immobilization; begin active range of motion 2, 4
5. Weeks 6-12: Progress passive to active motion 4, 5
6. Week 12+: Begin strengthening exercises, as tendon-to-bone healing is unlikely before 12 weeks 4

Important Caveats

• These recommendations apply specifically to small to medium tears of the supraspinatus and upper infraspinatus 2
• Larger or more complex tear patterns may require individualized approaches based on repair tension and construct 4
• Some patients report that prolonged sling use (4+ weeks) actually increases pain rather than relieving it 6
• The primary purpose of immobilization is pain control and preventing further injury during the acute phase, not improving healing 1