A sling does not need to be worn for a rotatory cuff injury. However, if you have undergone rotator cuff surgery, you will likely wear a sling for six weeks to allow the surgical site to heal and strengthen before introducing any traction forces.
When should you wear a sling for a rotator cuff injury?
If you have recently had rotator cuff surgery, the majority of surgeons will recommend that you should wear the sling for six weeks, including when you’re sleeping.
Some people have the concern that the shoulder will get too stiff if you immobilize it in a sling while at rest for six weeks, however, this fear is largely unfounded as the shoulder will be stiff, regardless.
The primary reason that most surgeons want to wait six weeks before getting out of the sling is that it’s shown to have better outcomes, namely a decreased re-tear rate.
It is worth noting that RTC retears are pretty common so I encourage you to read this article about whether you should even get the surgery or not.
Other reasons you should wear the sling if you haven’t had the surgery would be severe and intractable pain that only feels better when it’s in the sling.
I’m generally not a huge fan of immobilizing a body part for an extended period of time if there has not been a surgical procedure, done, as it often creates more pain, avoidance, and worst of all, decreased muscle mass. This makes the rehab process more difficult.
When should you not wear a sling for a rotator cuff injury?
As I shared briefly, above, I do not recommend you wear a sling any other time other than if you are post-op in weeks zero to six.
If you are wearing a sling outside of that because it helps with pain, I would recommend considering not doing that, but also keeping it at a minimum if you must.
It would be better to use ice, heat, and different exercises to see if you can improve symptoms.
This will help keep your shoulder more mobile and reduce the risk of the shoulder locking up and turning into a frozen shoulder.
Will the tear get worse if you don’t wear a sling?
There is no evidence that I have seen that says you are at a higher risk if you don’t wear a sling and you have a partial rotator cuff tear.
That’s not to say that it’s not possible, however, if this issue was happening to me, I wouldn’t be worried about it.
What is a rotator cuff injury?
A rotator cuff injury, often mistakenly called a rotary cup, is defined as pain, weakness, and decreased sensation of stability or any combination of those, at the shoulder.
A rotator cuff can be strained or completely torn and these tears are graded in three stages.
Grade one is a minor strain with no significant tearing.
Grade two would be considered a partial thickness tear.
Grade three is defined as a full-thickness rotator cuff tear.
Interestingly enough, having a grade three tear does not mean you will need surgery. In many cases, people live with full-thickness RTC tears and don’t even know they have them. This has been confirmed in several studies where they took MRIs of asymptomatic people who were then found to have rotator cuff tears. (source)
When do you need surgery?
I’ve explained this at length in another article, however, I’ll be brief, here.
You likely need surgery if you can’t lift your arm, or have severe pain that has persisted longer than 6 months even after going through extensive, high-quality physical therapy.
I’ve had too many clients come in over the years who can lift their arms straight over their head without any weakness whatsoever and who are told they need surgery.
That is utter nonsense and whoever is recommending surgery to them needs their license to be revoked, or, at the very least, that person needs to be updated on the best available evidence around rotator cuff tears and when surgery is indicated, which I’ve also covered in other blog posts.
What is a sling and how does it work?
Well, I think a sling is pretty self-explanatory once you see a picture…
Its main function is to immobilize the shoulder and reduce the traction forces that are experienced at the shoulder joint.
Since the rotator cuff muscles are active “at rest” to stabilize your shoulder, without a sling, they are always working when you are in an upright position.
There are two basic types of slings that are used for a RTC repair.
Shoulder sling with an abduction pillow (amazon link to Don Joy – this is the most popular sling), and then just some run-of-the-mill, old-school slings without the abduction pillow.
Abduction just means that the arm is away from the body. It is the action of moving the arm away from the body and increasing the angle as measured by looking at the armpit.
The abduction pillow places the shoulder in about 30 degrees of abduction which further reduces the traction forces that are placed upon the shoulder if you were in a regular sling without the abduction pillow.
My clients have said these are much more comfortable than the regular slings.
The only downside about the Don Joy slings and other slings with abduction pillows is that they are a bit bulkier and so you might have to be a bit more creative when walking through doorways and such. But, this only lasts for six weeks or so.
Slings are widely used post-op for rotator cuff repair however they do not need to be used if you are not undergoing a surgical procedure.
It’s best to find a rehab program that works for you, first, try that out, and then if that doesn’t work then proceed with a surgical procedure. This is always on a case-by-case basis.
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