In this month’s Journal of Shoulder and Elbow Surgery…

The Position of Sling Immobilization Influences the Outcomes of Anatomic Total Shoulder Arthroplasty: a Randomized, Single-blind, Prospective Study

Journal of Shoulder and Elbow Surgery, 2018-12-01, Volume 27, Issue 12, Pages 2120-2128, Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees


In this month of Journal of Shoulder and Elbow Surgery, the authors evaluated the position of the arm after an anatomic total shoulder replacement when wearing a sling postoperatively.  They looked at the position of the arm in a neutral position with the arm at the side and the hand pointing forward versus the position of the arm internally rotated with the arm across the chest.


36 patients were analyzed at 2 weeks, 6 weeks, 3 months, 6 months and 1 year.

Currently there does not seem to be a consensus regarding optimal position for postop immobilization after total shoulder arthroplasty and whether that position of immobilization has an effect on motion and functional recovery.

The authors evaluated for different parameters after total shoulder arthroplasty.  They looked at decrease postop pain, decreased night pain, improved range of motion into different arm positions postoperatively.  This study was based on the rationale that the shoulder joint is in a more neutral position when the center of the humeral head is better aligned with the center of the glenoid and this might maintain a more balanced tension across the anterior and posterior soft tissue structures including ligaments and rotator cuff with the arm in neutral position and when the arm is placed in a position of internal rotation with the arm across the chest.


The study concluded that there were greater improvements with the use of a neutral rotation sling after total shoulder arthroplasty for external rotation motion, with significant improvements in active and passive external rotation.  They also found improvements in other measured ranges of motion postoperatively with the arm in a neutral position as opposed to internal rotation.  These improved ranges of motion included active forward flexion as well as active and passive adduction.

At 2 weeks after surgery, patient is in the neutral rotation group had much less night pain in patients using the arm with the arm in internal rotation.  Overall even at 12 months postoperatively, the neutral rotation sling group had overall better pain relief.


In conclusion, after an anatomic total shoulder arthroplasty, the arm immobilized in a position of neutral rotation demonstrates improved motion and diminished night pain than the arm immobilized in internal rotation.

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