Treatment of shoulder dislocation: is a sling appropriate?

George A C Murrell
Med J Aust 2003; 179 (7): 370-371.


  • Acute anterior shoulder dislocations, when managed non-operatively, have traditionally been treated by placing the arm in a sling. There is no formal evidence that this treatment is of benefit.

  • Three recently reported studies, one in cadavers and two in patients, suggest that the detachment of the structures in the front of the shoulder is made worse when the shoulder is placed in internal rotation, as when the arm is in a sling. By contrast, the structures are realigned when the arm is placed in external rotation.

  • Shoulder dislocations, if managed non-operatively, should not be treated by placing arms in a sling. Rather, placing them in a splint or using a pillow so that the the arm is externally rotated should be considered.

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  • George A C Murrell

  • Orthopaedic Research Institute, Department of Orthopaedic Surgery, St George Hospital, Kogarah, NSW.


Competing interests:

None identified.

  • 1. Hayes K, Callanan M, Walton J, et al. Shoulder instability — management and rehabilitation. J Orthop Sports Phys Ther 2002; 32: 497-509.
  • 2. Paxinos A, Walton J, Tzannes A, et al. Advances in the management of traumatic anterior and atraumatic multidirectional shoulder instability. Sports Med 2001; 31: 819-828.
  • 3. Kirkley A, Griffin S, Richards C, et al. Prospective randomized clinical trial comparing the effectiveness of immediate arthroscopic stabilization versus immobilization and rehabilitation in first traumatic anterior dislocations of the shoulder. Arthroscopy 1999; 15: 507-514.
  • 4. Bankart ASB. The pathology and treatment of recurrent dislocation of the shoulder-joint. BMJ 1938; 26: 23-29.
  • 5. Warner JJ, Miller MD, Marks P, Fu FH. Arthroscopic Bankart repair with the Suretac device. Part I: Clinical observations. Arthroscopy 1995; 11: 2-13.
  • 6. Walton J, Paxinos A, Tzannes A, et al. The unstable shoulder in the adolescent athlete. Am J Sports Med 2002; 30: 758-767.
  • 7. Itoi E, Sashi R, Minagawa H, et al. Position of immobilization after dislocation of the glenohumeral joint. A study with use of magnetic resonance imaging. J Bone Joint Surg Am 2001; 83-A(5): 661-667.
  • 8. Hatrick C, O'Leary S, Miller B, et al. Should acute anterior dislocation of the shoulder be treated in external rotation. Transactions of the 48th Annual Meeting of the Orthopaedic Research Society. Dallas, Texas; 2002. Available at: (accessed Aug 2003).
  • 9. Itoi E, Hatakeyama Y, Kido T, et al. A new method of immobilization after dislocation of the shoulder: a prospective randomized study. 70th Annual Meeting of the American Academy of Orthopaedic Surgeons; 2003 Feb 5-9; New Orleans, La. Available at: (accessed Aug 2003).
  • 10. Itoi E, Hatakeyama Y, Kido T, et al. A new method of immobilization after traumatic anterior dislocation of the shoulder: a preliminary study. J Shoulder Elbow Surg 2003. In press.
  • 11. Bottoni CR, Wilckens JH, DeBerardino TM, et al. A prospective, randomized evaluation of arthroscopic stabilization versus nonoperative treatment in patients with acute, traumatic, first-time shoulder dislocations. Am J Sports Med 2002; 30: 576-580.


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