A shoulder dislocation occurs when the head of the upper arm bone (humerus) is forcibly separated from its socket (glenoid). Because of its wide range of motion, the shoulder is the body’s most frequently dislocated joint. Following the medical procedure of reduction, where the bone is guided back into the socket, the joint requires strict immobilization. This stabilization protects the ligaments, tendons, and joint capsule damaged during the injury.
Why the Sling Must Stay On During Sleep
Keeping the sling on while sleeping is highly recommended, particularly in the initial weeks of recovery, because the primary risk is re-dislocation due to unconscious movement. While awake, you can consciously protect the injured arm, but during sleep, the protective tension provided by the surrounding muscles is lost. This relaxation increases the joint’s vulnerability to uncontrolled movements, such as rolling over or reaching out.
The sling maintains the arm in internal rotation and adduction, holding the elbow close to the body. This specific position minimizes strain on the healing joint capsule and ligaments. Removing the sling allows the arm to drift into positions, especially external rotation and abduction (moving away from the body), which can cause the humerus to slip out again (recurrent dislocation). A second dislocation compounds the initial damage, making future instability more likely.
Recommended Sleeping Positions
Finding a comfortable and safe sleeping position is a primary challenge, but several strategies can help protect the healing shoulder. The most stable position is to sleep on an incline, known as the Semi-Fowler’s position. This can be achieved using an adjustable bed, sleeping in a recliner chair, or propping the upper body up with a stack of pillows or a wedge cushion. Sleeping in a reclined position, typically at an angle of 45 degrees or more, prevents the body from rolling flat onto the injured side.
When using a bed, create a supportive “nest” of pillows around the body and the injured arm. Place a pillow directly behind the injured arm and shoulder to prevent the arm from falling backward or the body from rolling onto the back. If you attempt to sleep on the uninjured side, place a pillow lengthwise in front of the chest and “hug” it. This action supports the injured arm and prevents it from pulling away from the torso, ensuring the joint remains protected throughout the night.
When to Discontinue Nighttime Sling Use
The duration for wearing the sling at night is highly individualized and must be determined by the treating physician or physical therapist. A common initial timeline for continuous sling use is between one to six weeks, depending on the severity of the injury and the patient’s age. Younger patients or those with significant soft tissue damage may require a longer period of immobilization to allow the labrum and ligaments to heal securely.
The decision to discontinue nighttime use often lags behind the removal of the sling during the day, as the risk of uncontrolled movement remains higher during sleep. Even after a patient is cleared to remove the sling during the day for exercises, they may be instructed to keep it on at night for several more weeks. You must receive medical clearance before removing the sling at night, even if the shoulder feels stable and pain has significantly reduced. Premature removal can lead to a setback in the recovery process, potentially requiring a restart of the immobilization phase.
Monitoring for Complications
During the recovery period, it is important to monitor the injured arm for any signs of complications that require immediate medical attention. A shoulder dislocation can sometimes cause damage to the surrounding nerves and blood vessels. A persistent feeling of numbness or intense tingling in the fingers, hand, or down the arm may indicate nerve compression or injury, such as to the axillary nerve.
The hand on the injured side should also be checked for changes in circulation; look for paleness, a cold sensation, or a blue tint, which could suggest a vascular issue. A sudden, sharp increase in pain that is not relieved by prescribed medication, or the appearance of excessive swelling, redness, or fever, could signal a more serious problem or an infection. If any of these warning signs appear, especially if they worsen, contact a healthcare professional immediately.