A two-strap arm sling, often called a shoulder immobilizer, is a specialized orthopedic device designed to restrict arm movement more completely than a single-strap sling. This type of sling provides enhanced stability and support, typically required after significant injuries, such as shoulder dislocations, severe sprains, or certain surgical procedures. The dual straps hold the arm securely against the body, minimizing unwanted motion that could interfere with the healing process. This comprehensive immobilization helps reduce pain and ensures injured structures remain in the correct anatomical position for recovery.
Preparation Before Application
Ensure the injured person is positioned comfortably, ideally seated in an upright chair with back support. Confirming the sling is the correct size is necessary; a sling that is too large will not provide adequate immobilization, while one that is too small may cause circulation issues. Check the sling and its straps to ensure they are untangled and that all buckles or fasteners are functioning smoothly.
If a healthcare provider has recommended specific padding, such as a rolled towel or abduction pillow, ensure it is placed correctly against the torso and under the armpit of the injured side. The injured arm should be bent at the elbow, usually close to a 90-degree angle, and gently supported by the uninjured hand or a helper. This initial positioning minimizes movement during the actual placement of the sling.
Step-by-Step Sling Placement
Gently slide the injured arm into the fabric pouch of the sling, ensuring the elbow fits snugly into the closed corner. The forearm should rest comfortably within the fabric, with the hand extending just to the edge, often supported by a thumb loop. Positioning the elbow correctly ensures the forearm is held at the desired angle, typically around 90 degrees of flexion, with the wrist slightly elevated above the elbow.
The two-strap system involves securing a shoulder strap and a body strap. The shoulder strap goes up and over the uninjured shoulder, crosses the back, and connects to the front of the sling, often near the wrist area. This strap bears the vertical weight of the arm, reducing strain on the shoulder and neck. Adjust the strap to be comfortably firm, supporting the arm’s weight without digging into the neck or shoulder.
The second strap, known as the waist or swathe strap, is wrapped horizontally around the torso and the injured arm. This strap typically starts on the back, wraps around the body, crosses the injured arm, and secures to the front of the sling pouch. The purpose of this strap is to secure the injured arm tightly against the body, preventing it from swinging outward or rotating.
Securing the Swathe Strap
Properly securing the swathe strap differentiates the two-strap immobilizer from a standard sling, providing greater stability. Fasten both straps using the quick-release buckles or Velcro tabs provided. Make small adjustments until the arm is held close to the abdomen and movement is significantly restricted.
Checking for Proper Support and Circulation
Once the sling is in place, check thoroughly for optimal support and safe circulation. Visually confirm the elbow is fully seated in the corner of the pouch and the wrist is supported, maintaining the slightly elevated position that assists with fluid drainage. The straps must feel snug enough to prevent unwanted arm motion but must not cause excessive pressure on the neck, shoulder, or chest.
To check for restricted blood flow, perform a capillary refill test by pressing on a fingernail of the injured hand until it turns pale. The pink color should return within two seconds; a delayed return suggests the straps are too tight and are impeding circulation. Signs of neurovascular compromise, such as numbness, tingling, or a cold sensation in the fingers, also signal that immediate adjustments are needed. Minor adjustments can be made until the arm feels securely immobilized without pain or restriction, and circulation remains unimpaired.