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Arm sling: which type you need and how it should sit
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- Padded pouch arm sling with adjustable shoulder strap. Best for: Wrist, hand or forearm injuries and below-elbow casts in adults. See options on Amazon
- Breathable mesh arm sling. Best for: Warm weather or long daily wear. See options on Amazon
- Child-size arm sling. Best for: Children with an arm cast or wrist injury. See options on Amazon
- Sling strap neck pad. Best for: Soreness where the strap crosses the neck. See options on Amazon
Types of arm sling and what each is for
Emergency departments use several sling styles, and the right one depends on the injury. The table below follows the patient leaflets from University Hospitals Sussex and the NSW Emergency Care Institute.
| Type | Typically used for | Arm position |
|---|---|---|
| Broad arm sling | Injured upper arm, wrist or forearm; also used for a rib fracture | Hand slightly higher than the elbow |
| High arm sling | Injury or infection below the elbow, such as the hand or forearm | Hand well raised, fingertips toward the opposite shoulder |
| Collar and cuff | Fractured collarbone or upper arm | Set by your clinician |
| Shoulder immobiliser | Shoulder dislocation, separation or surgery, rotator cuff injury | Arm held against the body |
Most pouch slings sold in shops hold the arm in a position similar to a broad arm sling. A collar and cuff or an immobiliser is chosen by the clinician who assessed the injury. For the last of these, see our page on the shoulder immobiliser.
How to size a pouch sling
Pouch slings are sized by forearm length, not by height or weight. As an example, AliMed tells buyers of its mesh arm sling to measure the forearm from the elbow to the base of the little finger, and lists these sizes:
- Small: 11 to 13 inches
- Medium: 13 to 14 inches
- Large: 14 1/2 to 15 1/2 inches
- X-Large: 15 1/2 inches or more
Other makers use their own charts, so check the one for the sling you buy. If you have a cast, measure with the cast on, since the pouch has to hold it. A pouch that is too short pushes the wrist over the edge. One that is too long lets the hand sag.
How a sling should sit
- Hand a little higher than the elbow. For a broad arm sling, the Sussex leaflet says the hand should sit slightly higher than the elbow, with the edge of the sling at the base of the little finger and the fingernails showing so you can check their colour.
- Strap or knot off the bone. The knot or buckle should not press on a bone or dig into the back of the neck.
- Shoulders level, not slumped. The Emergency Care Institute advises against slumping or rounding your shoulders when you stand or sit.
- Arm not hanging down for long. Frimley Health advises raising an arm in a cast to heart level when sitting and not letting it hang for long periods, as it may swell.
Moving, sleeping and washing in a sling
A sling is not meant to keep every joint still. For a high arm sling, the Sussex leaflet suggests taking the arm out, ideally every hour, to bend and straighten it, move the upper arm and shoulder and wiggle the fingers, within your range of movement. The Emergency Care Institute adds neck movements and notes that wearing a sling continuously can cause joint stiffness. Frimley Health says that with an arm in a cast, a sling can be worn for short periods and does not need to be worn constantly, unless a doctor has advised otherwise. Follow the plan you were given, since some injuries need stricter rest.
For sleep, adults usually keep the sling on for the recommended period. Children should have a sling removed for sleep because of a choking risk. Sleeping on your back or on the uninjured side, with a pillow under the injured arm, is the position the Emergency Care Institute suggests.
To wash, you can usually take the sling off if allowed, keep the arm close to your body and dry the armpit well. Put the injured arm into sleeves first when dressing.
Common mistakes
- Wearing the strap so long that the hand sits below the elbow, which can let the hand swell.
- Covering the fingertips, which hides colour changes.
- Never taking the arm out, when your clinician wanted gentle movement.
- Using a pouch sling in place of the collar and cuff or immobiliser you were prescribed.
What to look for when you buy
Padded pouch arm sling with adjustable shoulder strap
Best for: Wrist, hand or forearm injuries and below-elbow casts in adults
A closed pouch holds the forearm and hand at the slightly raised angle the Sussex leaflet describes for a broad arm sling. Check the maker's forearm size chart before ordering.
Watch out: Not a substitute for a collar and cuff or shoulder immobiliser if one was prescribed.
See options on AmazonBreathable mesh arm sling
Best for: Warm weather or long daily wear
AliMed describes its mesh sling as lightweight and breathable, with a 1-inch webbing strap and hook-and-loop closure. Mesh helps if the cotton pouch gets hot over a cast.
Watch out: Check the edges of the pouch for rubbing against skin or the end of a cast.
See options on AmazonChild-size arm sling
Best for: Children with an arm cast or wrist injury
A pouch sized for a short forearm keeps the hand from slipping out over the edge. Measure elbow to the base of the little finger as with adult slings.
Watch out: Remove it for sleep: the Emergency Care Institute warns of a choking risk for children.
See options on AmazonSling strap neck pad
Best for: Soreness where the strap crosses the neck
The Sussex leaflet says the knot or strap should not press into the skin at the back of the neck. A soft pad spreads that pressure.
Watch out: Do not lengthen the strap to fit a pad; keep the hand slightly higher than the elbow.
See options on AmazonQuestions people ask
- How should an arm sling fit?
- For a standard broad arm sling, the hand should sit slightly higher than the elbow, with the sling ending at the base of the little finger so the nails are visible. The strap should not press on a bone or the back of the neck.
- Should I sleep with my arm sling on?
- Adults usually keep it on for the period their clinician recommends. Children should have it removed for sleep because of a choking risk.
- How do I know what size sling to buy?
- Measure the forearm from the elbow to the base of the little finger and match it to the maker's chart. Measure over the cast if you have one.
- How long do you wear an arm sling?
- It depends on the injury, so follow your clinician. Frimley Health says that with an arm cast, a sling can be worn for short periods and does not need to be worn all the time, unless a doctor advises otherwise.
- Can I take my sling off to shower?
- Often yes, if your clinician allows it. Keep the arm close to your body and dry your armpit well afterwards.
Sources
- Slings and bandages: advice for patients seen in the Emergency Department (uhsussex.nhs.uk), University Hospitals Sussex NHS Foundation Trust
- Slings: patient fact sheet (aci.health.nsw.gov.au), NSW Agency for Clinical Innovation, Emergency Care Institute
- Instructions and advice about your plaster cast: upper limb (fhft.nhs.uk), Frimley Health NHS Foundation Trust
- AliMed Mesh Arm Sling (alimed.com), AliMed