Shoulder immobilization is a temporary first aid technique used to stabilize an injured arm or shoulder, often following a fracture, subluxation, or dislocation. This method prevents further movement of the injured joint and manages pain until a medical professional can provide definitive treatment. Proper stabilization transfers the weight of the forearm away from the injured shoulder joint to the upper back and neck. The goal is solely to stabilize the limb in its most comfortable position, not to fix the underlying injury.
Assessing the Injury and Prioritizing Safety
Before attempting any immobilization, confirm that the injury is suitable for this type of first aid and prioritize the safety of the injured person. Responders should never attempt to push a visibly displaced or dislocated shoulder back into its normal position. If the person is holding their arm in a guarded, protective posture, this often indicates a serious injury has occurred.
A thorough check for signs of a severe wound, such as visible bone or excessive bleeding, must be completed first. The responder must check the circulation, sensation, and movement (CSM) in the injured arm before applying any bandages. This involves confirming the hand and fingers are pink, warm to the touch, and that the injured person can still feel sensation and move their fingers.
The materials needed for a sling and swathe typically include two triangular bandages, which can be improvised from scarves, wide cloth strips, or other materials. After confirming good circulation and gathering the necessary items, position the arm comfortably to anticipate the sling’s support. The injured arm should be folded across the chest, with the hand positioned slightly higher than the elbow to help reduce swelling.
Constructing and Applying a Standard Sling
The sling’s function is to take the weight of the extremity off the injured shoulder joint. To begin, the responder should place the wide, longest edge of the triangular bandage parallel to the person’s body and slide it under the injured arm. The point of the triangular bandage should be positioned near the elbow, and one end of the bandage should drape over the shoulder on the uninjured side.
The other end of the bandage is brought up and over the shoulder on the injured side to meet the first end. Ensure the sling material supports the entire forearm, extending to the base of the little finger. The two ends should be tied together in a secure knot, placed in the hollow just above the collarbone on the uninjured side, away from the spine.
The knot placement avoids pressure on the neck vertebrae and makes the person more comfortable during transport. Once the knot is secure, the responder should adjust the sling so that the elbow is fully cupped and supported by the point of the bandage. If the sling is too loose, the arm will hang too low, placing unwanted stress and strain on the shoulder joint.
The final adjustment involves twisting the excess material at the elbow point until it fits snugly around the elbow. This twisted tip can be secured with a safety pin or tucked in to prevent the elbow from slipping out. The sling must support the arm in a flexed position, ideally with the elbow bent at a 90-degree angle.
Securing the Arm with a Swathe
Once the arm is suspended in the sling, use a swathe—a second broad piece of material—to bind the arm against the torso. The swathe prevents the arm from swinging or moving away from the body, ensuring complete shoulder immobilization. This secondary stabilization is achieved by wrapping the swathe around the injured arm and the person’s chest.
The swathe should be positioned over the injured arm, covering the elbow and upper arm for broad surface area coverage. It is wrapped around the back and under the armpit of the uninjured side, then secured back in the front. A wider swathe is generally preferred for this step as it provides better stabilization and is less likely to dig into the skin.
When securing the swathe, it must be snug enough to hold the arm firmly against the body but not so tight that it restricts breathing or cuts off circulation. The responder can ask the person to take a deep breath before tying the final knot to ensure the tightness does not impede full chest expansion. After securing the swathe, immediately recheck the circulation, sensation, and movement in the fingers of the injured hand.
The color and temperature of the fingers should be monitored. Capillary refill time can be checked by pressing on a fingernail for five seconds; the color should return within two seconds when pressure is released, indicating adequate blood flow. If the fingers become discolored or the person reports tingling or numbness, the swathe and sling must be immediately loosened and reapplied.
Ongoing Care and Seeking Professional Help
After the shoulder is immobilized, continuous monitoring of the injured person is required until professional medical care is available. The person should be transported in a sitting or semi-sitting position if their condition allows. Applying cold packs to the injury site, if available and tolerable, can help reduce localized swelling, provided the cold pack is placed on the outside of the dressing.
The responder should check the injured person’s circulation, sensation, and pain levels every 10 minutes following the immobilization. Loss of feeling in the hand or fingers, or color changes such as a blue or white tint, are warning signs of potential circulation problems that require immediate attention. If such signs appear, the tightness of the sling and swathe must be reassessed and adjusted.
For severe injuries, such as an obvious deformity or suspected dislocation or fracture, emergency medical services should be contacted immediately. If the injury is less severe but the person is in significant pain, transport them to an emergency department for a medical evaluation. Immobilization is only a temporary measure, and the injured person needs a medical diagnosis and treatment plan.