A post-operative shoulder sling is a medical device designed to keep the arm and shoulder completely still following surgery. Its primary role is to ensure the arm remains in a protected, neutral position, minimizing tension on the repaired tissues. By immobilizing the shoulder, the sling provides a stable environment for the initial biological healing process. This protection shields delicate sutures and anchors from accidental strain or sudden movements.
Variables That Determine Duration
The total length of time a patient must wear a sling varies significantly, typically ranging from two to eight weeks, with four to six weeks being common. This duration is a prescription tailored to the type of surgery performed and the integrity of the repair.
Procedures involving soft tissue reattachment, such as rotator cuff repair, often require four to six weeks of immobilization for the tendon to securely re-incorporate with the bone. Labral repairs (Bankart or SLAP procedures) also generally necessitate four to six weeks. In contrast, total shoulder replacement or hemiarthroplasty may require a shorter sling period, sometimes only one to two weeks, allowing for an earlier introduction of passive motion.
Individual patient factors, including age, overall health, and conditions like diabetes, also influence the healing timeline. The surgeon’s specific protocol is the ultimate determinant, considering the severity of the original injury and the tension required for the surgical repair. A high-tension repair, where tissue was significantly retracted, may warrant a longer period of sling use to ensure biological fixation.
Understanding Sling Use Protocols
Sling use progresses through distinct phases of wear rather than remaining uniform throughout recovery. The initial phase involves continuous use, where the sling is worn 24 hours a day, including while sleeping, typically lasting the first two to four weeks. This strict immobilization prevents inadvertent motions, which are a common risk during sleep.
Patients are advised to sleep in a reclined position, which provides comfort and helps keep the arm slightly away from the body to reduce strain. The sling may be briefly removed only for specific hygiene tasks, such as showering, or to perform prescribed hand, wrist, and elbow exercises. During these activities, the arm must remain supported, and all active shoulder movement, such as lifting or pushing, must be strictly avoided.
Following the initial period, the protocol transitions into a gradual weaning phase, which may continue until six to eight weeks post-surgery. The patient may be permitted to remove the sling while sitting comfortably at home or during controlled activities like desk work. However, the sling remains mandatory when in public, in crowds, or while walking to protect the arm from accidental bumps.
Why Premature Removal Is Dangerous
Discontinuing sling use before receiving explicit clearance from the surgeon significantly risks compromising the surgical outcome. The most severe consequence is a re-tear or complete failure of the repair, occurring when excessive stress pulls the healing tissue away from the bone. This failure often necessitates a second, revision surgery, which is typically more complex and carries a less favorable prognosis.
For stabilization procedures, premature removal can lead to joint instability or dislocation, jeopardizing the surgery’s intended goal. Even minor, unintentional movements create tension at the repair site, diverting the body’s energy from healing. Non-compliance can delay overall recovery time and increase the risk of developing a chronic issue.
Beginning the Rehabilitation Process
The full discontinuation of the sling marks the beginning of the active rehabilitation phase, a structured, long-term commitment. Physical therapy is immediately initiated, focusing on restoring the joint’s range of motion while protecting the surgical repair.
The first exercises are Passive Range of Motion (PROM), where a therapist moves the arm without the patient engaging the shoulder muscles. These controlled motions, such as gentle forward elevation and external rotation, prevent excessive stiffness from prolonged immobilization. The patient must relax the shoulder completely, ensuring no active muscle contraction interferes with the passive stretch.
This passive phase is followed by Active-Assisted Range of Motion (AAROM), where the patient uses their non-operative arm, a cane, or pulleys to help move the surgical arm. True active motion, where the patient moves the arm entirely on their own, and resisted strengthening are introduced much later, often several months after surgery. The entire rehabilitation process often lasts four to six months.