Slings in Occupational Therapy

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Slings in Occupational Therapy
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Patient Population

• Brachial Plexus Injury, CVA, SCI or Central cord
  syndrome (greater loss of motor function in UEs
  than LEs), Humeral Fracture, Rotator Cuff
  Injury, Crush Injury, other shoulder surgery

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Purpose

• Immobilize UE
• Decrease load on tissues
• Prevent subluxation
• Prevent brachial plexus traction
• Facilitate ROM (dynamic)
• Support associated joints/tissue

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Desired Positioning

• Aligns joints
• Maintains tissue length
• Avoids
• Long term internal rotation, elbow flexion, and
  adduction unless indicated by specific protocols

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Considerations For Choice

• Wear and Maintenance
• can it be washed
• don doffed easily
• durability (foam breaks down)
• Cosmetic appeal
• Cost
• fabrication time
• materials

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cont

• Does it discourage or promote use and sensation?
• Avoids shear forces
• Distributes weight broadly, avoiding C7 and
  cervical areas
• Edema prevented
• Does it truly achieve its intended purpose???????

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Slings For Flaccid UE S/P CVA
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Food for thought

• It has been reported that up to 94 of therapists
  use slings despite a lack of studies supporting
  or rejecting the use of slings
• Some studies show no difference in shoulder
  subluxation in patients who receive tx. with
  slings tx. without slings (Hurd Associates)

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cont

• Therapists reported that slings were used to
  decrease subluxation and pain
• Studies by Joynt, Roy associates, Bohannon and
  Andrews, and Zorowitz all showed no correlation
  between shoulder pain and subluxation.

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Carefully consider the goal of the sling
subluxation prevention, pain prevention, or
glenohumeral alignment.
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Subluxation

• Alignment and approximation of humeral head to
  glenoid fossa
• Measured vertically and horizontally

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Measuring Subluxation

• Palpation
• Seated
• Trunk alignment stability provided if needed
• UE is unsupported at the side with neutral
  rotation
• Palpate between acromion and superior aspect of
  humeral head
• O to 51/2 finger widths scale
• X-Ray

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Overall Shoulder Alignmentto Prevent Pain
Subluxation

• angle of glenoid fossa when forward, up and out
  (upward rotation)
• support of the scapula on the ribcage
• superior capsule integrity
• seating of the humeral head via the supraspinatus
• contraction of deltoid and cuff muscles (assists
  during abduction of humerus)

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Correct Joint Alignment

• No sling is available to correctly position the
  scapula on the rib cage in order to maintain
  correct scapular alignment on the ribcage
• Total shoulder alignment will remain incorrect
  (this may lead to pain or impingement)

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Subluxation Vs Overall Joint Position

• Subluxation of the humerus from the glenoid fossa
  is often measured but overall position of the
  scapula is not considered.
• Slings can only lift the head of the humerus to
  approximate the glenoid fossa
• Without upward rotation of the scapula rotator
  cuff motor function, subluxation over time is
  likely

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Caution

• Forced abduction/flexion without external
  rotation can result in impingement and pain
• External rotation and subscapularis length must
  be maintained to avoid pain during
  flexion/abduction of humerus. Avoid prolonged use
  of slings which maintain internal rotation.
• The scapula must be upwardly rotated to avoid
  other subacromial impingements

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Hook Hemi Harness

• 2 shoulder cuffs
• strap that tightens as effected arm is raised
• Allows internal/ext rot

• Not found to prevent subluxation or humeral
  alignment

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Rolyan Humeral Cuff Sling(Rolyan Hemi Arm Sling)

• O ring with dynamic straps
• 1Humeral cuff

• Can be worn under clothing
• Moderately corrected vertical displacement of
  humerus
• Allows external rotation ROM

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2 Cuffed Hemi-slings(Harris Hemi Sling/Rolyan
Universal Sling )

• 2 cuffs for elbow wrist
• arm in add., int. rot., elb. flex.
• Figure 8 strapping
• Chest cuff straps

• Approximates Glenohumeral alignment
• Helps prevent subluxation
• Does not prevent pain
• Promotes shoulder subscapularis contracture

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Rolyan Universal Sling
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Harris Hemi Sling
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Bobath Roll

• Figure 8 axilla rolls

• Precautions
• Can cause brachial plexus compression
• Can cause lateral subluxation of the humeral head
  if rotator cuff is flaccid

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Shoulder Saddle Sling

• Shoulder saddle with humeral cuff
• Dynamic straps

• No research is available
• Permits elbow flexion/extension

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Why use a sling after a CVA?

• Maintain humeral placement and soft tissue
  integrity if rotator cuff function is expected to
  return
• Prevent injury of flaccid extremity during
  transfers and mobility

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Arm Trough / Lap Board

• Maintains humeral alignment in glenoid fossa
• arm can be rotated externally
• limits mobility and function to w/c

• Can over correct glenohumeral alignment
• Rotation depends on position of patients arm

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Slings for other diagnoses
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Static Trunk Based Shoulder/Elbow/Wrist Orthosis

• Provides stability at elbow and/or shoulder. Can
  position hand for function or immobilization
• Brachial Plexus injury
• Shoulder fusion or capsule instability
• Rotator cuff repair

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Kohlmeyer- RIC orthosis

• Figure 8 straps with forearm cuff(s)
• Dynamic tubing fitted between cuffs and shoulder
  straps
• Used for patient with greater proximal weakness
  than distal weakness
• Central Cord Syndrome Brachial Plexus injury

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Humerus-stabilizing Orthosis

• Stabilizes humeral fracture
• Nonarticular splint
• Also called coaptation splint
• Coaptation(join together of 2 surfaces)

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Static-Progressive Elbow Flexion Harness

• Used for extension contractures and S/P elbow
  arthroplasty
• Distribute force of pull through both shoulders
  and the waist
• Consider extension of elbow
• Avoid holding elbow flexed all the time
• Alternate with extension orthosis if needed

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Bobath Roll (used for burns, contractures in
axilla, or kyphotic posture)

• Figure 8 axilla rolls
• Provides stretch to anterior chest and increases
  axilla tissue length

• Precautions
• Can cause compression of the brachial plexus