A sling is a temporary device used to support and immobilize an injured upper limb, including the hand, wrist, forearm, elbow, or shoulder. Its primary function is to transfer the weight of the injured arm to the neck and torso, preventing excessive movement that could cause further injury or increase pain. Proper application is a first aid measure that stabilizes the arm in a comfortable, supported position, which is important for suspected fractures or dislocations before transport to a medical facility.
Essential Preparation and Materials
Before applying support, gather the appropriate materials and prepare the patient and the injured limb. The standard temporary support is a large triangular bandage. In an emergency, any non-stretchy material measuring roughly one yard on each side, such as a large scarf or sheeting, can be used. The material must be strong enough to bear the full weight of the limb without tearing.
Position the injured person, ideally in a seated position, where the injured arm can be supported by the uninjured hand or a bystander. The elbow of the injured arm should be bent to approximately 90 degrees, resting against the patient’s chest. This right-angle position is the most comfortable and neutral for most upper limb injuries.
The hand should be positioned so the fingertips are slightly elevated above the level of the elbow. This elevation helps encourage venous return and reduce swelling. Before securing the arm, remove any restrictive jewelry, especially rings and bracelets, as the limb may swell rapidly following injury. This prevents the jewelry from restricting blood flow.
Step-by-Step Guide to Applying a Standard Arm Sling
Applying a standard broad arm sling, typically used for forearm or wrist injuries, begins by placing the triangular bandage correctly. Position the unfolded material with one end over the shoulder of the uninjured side, allowing the remainder to hang down in front of the chest. The base (the longest edge) should be parallel to the body. The apex (pointed corner) must be placed near the elbow of the injured arm.
Slide the hanging section of the bandage underneath the injured arm, ensuring the elbow rests snugly into the apex. The arm should be bent across the chest in the 90-degree position. The hand must be supported so the little finger is fully contained within the base of the sling. Bring the lower end of the bandage up and over the shoulder on the injured side, meeting the first end at the neck.
Fasten the two ends of the bandage together using a square knot, which lies flat and resists slipping. This knot must be tied over the shoulder on the uninjured side of the neck. Never tie the knot directly over the cervical spine or the collarbone of the injured side, as this prevents pressure on the vertebrae or a potentially fractured bone. To enhance comfort, place a small piece of padding, such as gauze, under the knot before tightening.
Once the knot is secure, manage the apex of the sling, which extends past the elbow, to complete the support. This excess material is twisted and then tucked or pinned securely at the back of the elbow to create a clean pocket that cradles the limb. The final adjustment ensures the fingers remain visible outside the sling’s edge for monitoring circulation. The sling should support the entire forearm, leaving only the fingertips exposed.
Recognizing Different Immobilization Needs
While the broad arm sling is suitable for many injuries, specialized techniques are necessary when the injury involves the upper arm, shoulder, or requires greater elevation. A collar and cuff sling is preferred for injuries to the upper arm, such as a fractured humerus, or for hand/wrist injuries requiring the hand to be held high to combat swelling. This method suspends the wrist and hand, allowing gravity to assist in stabilizing the upper arm.
The collar and cuff sling is constructed by folding the triangular bandage lengthwise into a narrow strip, known as a cravat. A loop or clove hitch knot is formed in the center of the cravat and placed around the patient’s wrist. The two ends of the cravat are brought around the neck and tied, positioning the forearm almost vertically against the chest. This takes the weight off the elbow and supports the wrist.
For injuries involving the shoulder joint, such as dislocations or fractures, a swathe or binder is often used in addition to a standard sling. The swathe is a second, wide piece of material, such as another triangular bandage or a belt, wrapped around the torso and over the injured arm to secure it firmly against the body. This secondary immobilization prevents the arm from swinging or rotating, which can be painful or damaging to an unstable shoulder joint.
Improvisation is often necessary when a triangular bandage is unavailable, and various items can serve as a temporary sling. A long necktie or a belt can be looped under the forearm and tied behind the neck to form a quick, narrow support. Another technique uses a coat or shirt: place the injured arm inside the garment and pin the sleeve to the fabric across the chest, using the clothing as the supporting material.
Safety Checks and Professional Consultation
After the sling is applied, immediate assessment of the patient’s neurovascular status is mandatory to ensure circulation or nerve function has not been impaired. The assessment focuses on the exposed fingers, checking for color, warmth, and sensation (CWS). The fingers should retain their normal pink color and remain warm to the touch. The patient should also be able to feel light touch and wiggle their fingers normally.
If the fingers appear pale, blue-tinged, or feel cold, or if the patient reports numbness, tingling, or increased pain, the sling is likely too tight and must be immediately loosened and readjusted. These signs indicate compromised blood flow or nerve compression, requiring prompt correction. The patient should also be asked about the comfort of the knot; it should not press into the neck or spine. Padding should be added if the pressure causes discomfort.
A correctly applied sling is only a temporary measure for stabilizing the injury. The patient must seek professional medical evaluation immediately after applying the support. A physician must examine the limb to diagnose the underlying injury, such as a fracture or dislocation, and determine the definitive course of treatment. Wearing a temporary sling does not replace the need for diagnostic imaging and comprehensive medical care.