| Physiotherapists and orthopedic surgeons spend | | | | go and the hand can be kept out of the sling by |
| significant amounts of time and effort treating | | | | folding back the cuff part. The small Velcro strap |
| shoulder injuries and conditions, of which there are | | | | to close the forearm gutter should not be tightly |
| many. The shoulder, an unstable joint with a very | | | | fixed as it may cut in to the upper arm, |
| large range of movement, the greatest in the | | | | particularly if there is a lot of oedema as swelling |
| body, is vulnerable in many situations to injury or | | | | can occur after fractures of the upper arm. |
| mechanical stresses. Its instability means it can be | | | | Tightening up the main strap which runs across |
| relatively easily dislocated in a fall or activity at | | | | the back and upwards over the shoulder is a little |
| end range. We use the arm to save ourselves if | | | | more difficult to achieve a good result. |
| we fall, making fractures common and heavy or | | | | Due to the materials from which the slings are |
| overhead work over time leads to rotator cuff | | | | made there is a degree both of elasticity and |
| tears. | | | | friction against surfaces when they are adjusted. |
| Due to the very large number of potential injuries, | | | | As the sling is adjusted and tightened up the |
| fractures and operations which can affect the | | | | elbow is often not well supported by the sling at |
| shoulder it is very important to know the exact | | | | all and patients are usually aware that the support |
| diagnosis and plan of treatment. Physiotherapists | | | | is not that good. The physiotherapist can easily |
| specialise in managing post-operative and | | | | feel that the sling is not giving the correct support |
| post-trauma shoulder problems, following the | | | | and if they just tighten up the strap it solely |
| surgical and trauma protocols agreed with the | | | | tightens up at the front but does not improve the |
| shoulder surgeons. On meeting the patient initially | | | | support of the arm. This needs another strategy. |
| a good strategy is to review the progress of | | | | To get the sling right needs two people, the |
| their case so far, as this can occasionally throw | | | | patient and a helper. The helper lifts the elbow of |
| up unexpected anomalies which need exploring. | | | | the affected arm in the sling while the patient |
| The patient should have a short time to tell their | | | | tries to let the shoulder relax. Then the helper |
| story or they may not feel they have been | | | | gets hold of the part of the strap along the back |
| heard. | | | | and pulls it up towards the shoulder, holding it |
| As the arm hangs from the shoulder and needs | | | | there. The helper lets go of the elbow and |
| effort to keep it in place, after operation or injury | | | | adjusts the strap whilst still holding the back part |
| it may be useful to relieve this load by using a | | | | of the strap under tension with the other hand. |
| sling. The typical triangular bandage broad arm | | | | Having completed this maneuver the elbow should |
| slings are not comfortable, difficult to apply, pull at | | | | now feel heavy and supported in the sling and the |
| the back of the neck and are not easily adjusted | | | | patient feel it is quite comfortable. |
| to the physiotherapist's requirements. Foam | | | | General advice to patients about sling |
| padding around the knot at the back of the neck | | | | management should be given to cope with daily |
| can help but the Seton type sling with Velcro | | | | activities, the sling only being off for dressing and |
| straps is much better tolerated by patients and is | | | | washing. To wash the armpit the patient should |
| much more adjustable and comfortable. | | | | hold their arm in a position as if the sling was on |
| To get the best fitting and most comfortable fit | | | | and then bend forward, allowing the arm to bend |
| for the sling the physiotherapist needs to take a | | | | forward with gravity. To put clothes on the |
| few actions for success. The gutter for the arm | | | | affected arm should be placed on first and with |
| should have the elbow placed back as far as it will | | | | no significant movement of the arm involved. |