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How To Apply a Shoulder Sling and Swathe

By

Miranda Lewis

, MD, University of Washington

Last full review/revision Jul 2021| Content last modified Jul 2021

A shoulder sling and swathe are used to both support the arm and immobilize the shoulder.

A shoulder sling supports the weight of the arm and limits arm movement but does not prevent movement of the shoulder. If it is necessary to also restrict shoulder motion, particularly internal and external rotation, a swathe should be added. Alternatively, a commercially supplied shoulder immobilizer can be used.

Indications

  • Shoulder dislocation after closed reduction
  • Humerus fractures after splinting
  • Acromioclavicular joint separation
  • Forearm or elbow injuries after splinting (a sling without the addition of the swathe is adequate)

Contraindications

  • None

Complications

  • Ulnar nerve compression may result if the sling is too short, allowing the wrist to hang out of the sling

Equipment

  • Sling
  • Elastic wrap, 10 cm (4 inch) wide

A commercial shoulder immobilizer is an alternative if available.

Additional Considerations

  • Shoulder immobilization can quickly cause joint stiffness (frozen shoulder).

Positioning

  • The patient should be positioned so that the operator has access to the patient's entire trunk; standing is preferred if other injuries permit.

Step-by-Step Description of Procedure

  • Maintain the elbow at 90° flexion, the wrist in neutral position, and the palm facing the trunk.
  • Place the olecranon into the corner of the sling.
  • Wrap the strap across the neck on the opposite side and attach to the front of the sling.
  • Adjust the length of the strap to support the arm in order to maintain the elbow at 90° flexion.
  • Wrap the elastic wrap horizontally around the outside of the sling and around the trunk under the unaffected arm to secure the arm to the trunk. This is the swathe.
  • Check distal neurovascular status (eg, capillary refill, distal sensation, finger flexion and extension).

Sling and swathe

Sling and swathe

Warnings and Common Errors

  • Make sure to maintain the elbow at 90° flexion.
  • Make sure that the sling is long enough to support the wrist. The wrist should not be allowed to hang out of the sling because doing so puts undue pressure on the ulnar nerve.

Aftercare

  • Depending on the injury, discuss with the patient about continuous immobilization versus early range-of-motion exercises.
  • Arrange or recommend appropriate follow-up.

Tips and Tricks

  • A cravat can be used as a makeshift sling.
  • If using a commercial shoulder immobilizer, there is typically an integrated strap which functions as the swathe. Follow the device instructions to secure the strap.

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