A shoulder sling is a temporary device used to support and immobilize an injured upper limb until professional medical care can be obtained. This stabilization holds the weight of the arm, allowing muscles around the shoulder joint to relax and reducing strain on fractured bones or torn soft tissues. Constructing a sling in an emergency is not a substitute for a comprehensive medical evaluation. The goal is to maintain the arm in a position of comfort and safety during transport.
Immediate Preparation and Safety Precautions
Before applying stabilization, assess the injury’s severity. If the injury involves an obvious bone protrusion, heavy bleeding, or a loss of sensation or pulse in the limb, contacting emergency medical services immediately must be the priority. Do not attempt to manipulate or “set” a bone or a dislocated joint, as this risks severe damage to nearby nerves and blood vessels. Removing rings, watches, or bracelets from the injured arm is advised, as swelling can quickly cut off circulation.
The most effective makeshift sling requires a large, non-stretching square piece of cloth, ideally measuring at least 40 inches on each side, sourced from a large scarf, sheet, or pillowcase. A second piece of material, like a belt or strip of cloth, is helpful for securing the arm against the body, along with safety pins for securing loose fabric.
Step-by-Step Guide to Making a Triangular Sling
The triangular sling begins by folding the large square of cloth diagonally into a triangle. This creates the broad, supportive base needed to distribute the arm’s weight across the back and shoulder. The injured arm should be gently supported across the chest, with the elbow bent to a roughly 90-degree angle, which is the most comfortable position for the joint.
Drape the triangular cloth across the chest, with the longest edge (the base) running parallel to the ground and positioned under the injured arm. The point of the triangle should extend past the elbow, and the wrist should rest midway along the base.
Bring one end of the base up over the shoulder on the uninjured side, and the other end up around the injured side. Tie these two ends together behind the neck to keep the knot from pressing directly onto the cervical spine. Adjust the knot so the arm rests securely across the chest. If padding is available, place it under the knot to prevent discomfort and chafing on the neck.
Alternative Methods for Stabilization
If a large piece of cloth is unavailable, other common items can provide temporary stabilization. A long-sleeved shirt or sweater can be converted into a sling by sliding the injured arm into the garment and tying the two sleeves together behind the neck. This method uses the shirt body to cradle the forearm, though it may offer less support than a triangular bandage.
The “immobile sling” technique involves pinning the sleeve of the injured arm directly to the clothing over the chest. Use large safety pins or tape to secure the forearm against the torso. For minimal support, a necktie or belt can be looped under the wrist and tied around the neck, but this concentrates the arm’s weight onto a small, uncomfortable area. Alternative methods should be viewed as last resorts, as they are less effective at fully immobilizing the shoulder and supporting the arm’s full weight.
Proper Application and Fit Check
Once the sling is constructed, a final check is necessary to ensure proper fit and to prevent neurovascular complications. The elbow should be fully supported by the point of the triangle, and the hand should be positioned slightly higher than the elbow to help prevent fluid from pooling. The fingers must remain exposed at the edge of the sling so that circulation can be monitored constantly.
To confirm adequate circulation, check the patient’s fingertips for color and temperature; pressing on a fingernail should show capillary refill, where color returns within two seconds.
The final step for shoulder injuries is applying a swathe, which is a second piece of material wrapped around the torso and the supported arm. This binder secures the arm tightly against the body, preventing it from swinging outward during movement and providing the immobilization needed for a shoulder or collarbone injury. The swathe should be tied on the uninjured side to avoid pressure on the injury site.