A shoulder sling is a temporary first-aid device used to immobilize and provide support to an injured arm, shoulder, or collarbone. It holds the arm in a comfortable, fixed position across the body to reduce movement that could increase pain or cause further damage. This immediate stabilization is a practical measure to make the injured person comfortable and safe for transport to professional medical care. The sling counteracts the pull of gravity on the arm, which can otherwise strain damaged muscles, tendons, or fractured bones.
Selecting and Preparing Improvised Materials
Finding a strong, non-stretchy material is the first step in creating an effective improvised sling. Suitable items include large scarves, bedsheets, pillowcases, or substantial pieces of clothing like large t-shirts or jackets. A square piece of cloth, ideally measuring around 40 inches (1 meter) on each side for an adult, provides the best foundation.
If the material is square or rectangular, fold it diagonally to form the necessary triangular bandage shape. This shape is the most effective for cradling the arm and distributing weight across the back and shoulder. The fabric must be durable enough to support the full weight of the arm without tearing; avoid slippery materials, like silk, which could shift out of position.
Step-by-Step Guide to Tying the Sling
The goal is to position the arm across the chest with the elbow bent at approximately a 90-degree angle. Place the triangular material with the longest edge (the base) running parallel to the body on the side opposite the injury. The point of the triangle (the apex) should be positioned just past the elbow of the injured arm.
Gently slide the material under the injured arm, which should be resting across the chest. The base of the triangle will extend under the forearm and up over the shoulder of the uninjured side. Bring the lower corner of the triangle, which is below the hand, up over the injured arm and toward the shoulder of the injured side.
The two ends of the sling should meet behind the neck. Tie these ends together using a secure knot, such as a reef knot, ensuring the knot rests to the side of the neck, not directly on the spinal area. The knot’s position determines the height of the arm, aiming for the wrist to be slightly higher than the elbow.
Finally, secure the point of the triangle (the apex) that extends past the elbow to complete the cradle. This can be done by twisting the excess fabric and tucking it into the front of the sling or by using a safety pin. This step prevents the elbow from slipping out and provides full support to the limb.
Checking for Proper Fit and Circulation
Once the sling is tied, check that it provides support without causing further harm. The hand and wrist should be positioned slightly higher than the elbow to encourage fluid drainage and reduce swelling. The elbow must be securely nestled in the apex of the sling, supporting the entire length of the forearm.
A crucial safety check is assessing circulation using the capillary refill test. Press firmly on a fingernail until the color drains, then release and observe how quickly the pink color returns. Color should return within two seconds; a slower return suggests restricted blood flow, requiring immediate loosening of the knot.
The patient must be able to comfortably wiggle all fingers, and the skin color and temperature of the injured hand should match the uninjured hand. Tingling, numbness, or cooling of the fingertips are signs of compromised nerve or blood flow that demand prompt adjustment. Repeat these circulation checks every 10 to 15 minutes, as swelling can increase after the initial injury.
When Professional Medical Attention is Required
A homemade sling is strictly a temporary measure until a person can access definitive medical care. Certain symptoms indicate a serious injury that necessitates immediate transport to an emergency room.
These urgent medical red flags include:
- Any visible deformity of the shoulder joint, such as a misshapen appearance or a bone protruding through the skin.
- Intense, unmanageable pain, numbness, weakness, or an inability to move the fingers, signaling potential nerve or vascular damage.
- Severe swelling or a lack of pulse in the wrist of the injured arm.
For any suspected fracture, dislocation, or severe soft tissue damage, the improvised sling only serves to minimize movement during transport.