What is the best way to treat an arm injury with an arm sling?

Arm Sling Use for Arm Injuries

For most acute arm injuries including fractures, sprains, and soft tissue trauma, immobilize the injured extremity in the position found using a padded splint rather than attempting to straighten it, and consider sling use primarily during ambulation to protect against traction injury—not as the primary immobilization method. 1

Primary Immobilization Strategy

Fractures and Suspected Fractures

• Do not move or attempt to straighten an injured extremity (Class III recommendation - harm) 1
• There is no evidence that straightening angulated fractures shortens healing time or reduces pain prior to permanent fixation 1, 2
• Stabilize the extremity with a padded splint in the position found if far from definitive healthcare 1, 2
• Splinting reduces pain and prevents further injury during transport 2, 3

Critical Exception: Neurovascular Compromise

• If the extremity appears blue, purple, pale, or pulseless, activate emergency services immediately 2, 3
• Consider gentle realignment to restore perfusion while awaiting definitive care only in cases of documented neurovascular compromise 2

Role of Arm Slings

When Slings May Be Considered

• Use slings during ambulation training specifically to protect the shoulder from traction injury, not as primary immobilization 1
• Slings may be appropriate for hemiplegic shoulder protection in stroke patients during mobility 1

Evidence Against Routine Sling Use

• A 2017 randomized controlled trial found that stroke patients who did NOT wear slings showed a 37.59% reduction in shoulder subluxation, while those wearing the Actimove sling showed essentially no improvement (-2.77%), and the Shoulderlift group actually worsened (+12.44%) 4
• The Actimove sling group reported significantly more pain at rest after 6 weeks (P=0.036) 4
• After carpal tunnel surgery, volumetric analysis showed no difference in swelling between sling and non-sling groups, with 38% finding the sling uncomfortable 5

Specific Management by Injury Type

Soft Tissue Injuries (Sprains/Strains)

• Apply cold (ice-water mixture in plastic bag or damp cloth) for up to 20 minutes at a time 1
• Place a thin towel barrier between cold and skin 1
• Refreezable gel packs are less effective than ice-water mixtures 1

Open Wounds with Fracture

• Cover open wounds immediately with a clean dressing to reduce contamination 2, 3
• Control hemorrhage with direct pressure before addressing fracture 3
• Initiate antibiotic prophylaxis immediately for open fractures 3

Post-Immobilization Care

Elevation and Ice Protocol

• Elevate the injured extremity 2, 6
• Apply ice for 20-minute intervals, 3-4 times daily with barrier between ice and skin 2

Weight-Bearing Restrictions

• Strict non-weight bearing for lower extremity injuries until orthopedic evaluation 1, 2
• For upper extremity, avoid overhead pulley exercises 1

Common Pitfalls to Avoid

• Over-reliance on slings as primary immobilization: Slings do not adequately stabilize fractures and may inhibit active correction of subluxation 4
• Attempting closed reduction in the emergency department unless documented neurovascular compromise exists 2
• Overtight splinting: Ensure adequate padding and monitor for compartment syndrome 2
• Aggressive passive range-of-motion exercises: If done improperly on complex joints like the shoulder, these may cause more harm than good 1
• Delayed mobilization of unaffected joints: Begin active motion exercises immediately for all unaffected joints to prevent stiffness 7

Return Precautions

Instruct patients to return immediately for:

• Increasing pain 2
• Numbness or tingling 2
• Color changes in the extremity 2
• Inability to move fingers/toes 2