Last updated: October 2026
Getting your arm back in the sling alone is a seated job. North Bristol NHS Trust gives it a separate instruction: sit down, keep the elbow at 90 degrees, rest the arm on a pillow, and slide the sling in from the side.
Key takeaways
- The North Bristol NHS Trust polysling leaflet gives two different methods: with a helper, the trough slides in from behind; alone, you sit down and slide it in from the side, with the arm supported on a pillow.
- The Lahey Hospital & Medical Center protocol has patients remove the sling 4 to 5 times a day for elbow, forearm, wrist and finger exercises, plus once for showering — about 210 to 250 refittings across a six-week sling period.
- Strap order matters more than strap tightness: forearm strap first (about one inch below the elbow crease), then wrist strap, then shoulder strap through the upper D-ring, then waist strap.
- An abduction pillow sling goes on in a different order. Oklahoma Shoulder Center starts the refit by leaning toward the operated side, and buckles the waist strap before the neck strap.
- The finished position is the test: elbow seated in the corner, knuckles facing forwards, wrist level with or slightly higher than the elbow.
- The operated arm does none of the work — North Bristol repeats that the unoperated arm lifts, feeds and fastens everything.
- Nothing here overrides your own discharge sheet. The protocols below disagree on sling duration — three, four and six weeks.
Why do you have to put the sling back on so many times a day?
Because the protocols ask for it. The sling is not meant to stay sealed for six weeks: it comes off for elbow and wrist movement, for washing, and in some protocols for dressing, then goes straight back on.
The Lahey protocol is the most explicit. For days 1 to 7 and again for weeks 2 to 4 it lists “Remove sling 4 to 5 times per day for gentle elbow, forearm, wrist and finger exercises” alongside “Remove sling for showering/bathing”. At 5 to 6 refittings a day across 42 days, that is roughly 210 to 250 times you fit the sling yourself.
| Protocol | Sling period | Times off per day | Also off for |
|---|---|---|---|
| Lahey Hospital & Medical Center | To end of week 6 | 4 to 5 (elbow, forearm, wrist, finger) | Showering, bathing |
| The Stone Clinic | 4 weeks | 3 exercise sessions, plus “frequently” for elbow bends | Sleep wear “optional depending on comfort” |
| Connecticut Orthopaedics | 3 weeks, pillow sling “at all times” | 3 exercise sessions | Showering, from day 3 |
Those numbers are the argument for learning the sequence properly once. Our 11-protocol comparison of night sling rules shows how widely the wear instructions vary.
What is different about refitting a sling with no one to help?
The entry direction changes. North Bristol’s step 2, for a helper, has someone slide the trough in from behind while you support the operated arm at 90 degrees. Step 3, for doing it yourself, is a different instruction: sit down, elbow at 90 degrees, and slide the trough in from the side.
The leaflet adds one thing to that step: “You will find it more comfortable if your arm is supported on a pillow.” That is the whole trick. A supported forearm is a forearm you are not holding, which frees the unoperated hand for the straps.
A firm surface at the right height does the same job as a helper. A kitchen counter, a table or a dense pillow on the lap can all sit the forearm at elbow height without you leaning. The Flexicomfort Shoulder Pillow is a 56 × 40 × 15 cm abduction wedge with two adjustable straps; the Aeris Wedge Pillow has a 65 × 65 cm base rising to a 22 cm apex.
What are the 5 things to set up before you start?
Setting up first removes most of the struggle, because every one of these is awkward to fix one-handed once the arm is in the trough.
- A seat with a firm surface at elbow height. North Bristol’s solo method is seated, with the arm supported.
- The straps pre-tidied. Oklahoma Shoulder Center, describing removal, says to Velcro the thumb and forearm straps “back onto themselves so they don’t get in the way”.
- The sling the right way up. In the North Bristol leaflet the wrist strap’s lower D-ring rests against the body and the upper D-ring faces upwards.
- Clothing already on. North Bristol dresses first, then puts the sling over the top “straight away”, unless you have been told it is for comfort only.
- The pillow or pad in place. Thin support lets the elbow sag out of the corner, which is the position the straps then lock in.
Our sling comfort guide covers the padding and skin checks that belong in the same routine.
How do you get your arm back in the sling step by step?
This is the North Bristol sequence, in its published order, for the solo method.
- Sit down with the elbow bent to 90 degrees and the forearm supported on a pillow.
- Slide the trough in from the side until the elbow is snug in the corner.
- Fasten the forearm strap across the forearm, about one inch below the elbow crease.
- Attach the wrist strap about one inch from the wrist, towards the elbow.
- Take the shoulder strap across the back and over the unoperated shoulder.
- Feed the shoulder strap through the upper D-ring on the wrist strap, then Velcro it back onto itself.
- If you were told to wear the waist strap, feed the other long strap through the lower D-ring, take it around the back, and attach it over the front of the elbow section.
The finished position, in the leaflet’s words, holds the arm “close to the front of your body with your knuckles facing forwards”, with the wrist slightly higher than the elbow — a detail North Bristol links to less swelling in the hand. Swelling that persists is covered separately in our guide to hand swelling after shoulder surgery.
Throughout, the unoperated arm does the lifting and fastening. North Bristol says plainly, for dressing, “Do not use your operated arm to help as you may move your shoulder too much and cause damage to the surgery on your shoulder.”
Does an abduction pillow sling go back on in a different order?
Yes. The bulky immobilizer worn after many rotator cuff repairs holds a pillow between the arm and the body, and Oklahoma Shoulder Center publishes its own sequence for taking it off and putting it back on.
| Step | Removal (Oklahoma Shoulder Center) | Refit (Oklahoma Shoulder Center) |
|---|---|---|
| 1 | Thumb and forearm straps off, Velcroed back on themselves | Lean to the side of the operated arm |
| 2 | Neck strap undone | Slide the arm into the sling |
| 3 | Waist strap removed | Forearm strap on |
| 4 | Sling slipped off, arm resting at the side | Waist strap reached behind and buckled, fingertips near the midline |
| 5 | — | Neck strap placed, elbow seated, thumb strap back over the thumb |
Two things stand out against the polysling method. The refit starts with a lean toward the operated side rather than a slide from the side, and the waist strap is buckled before the neck strap — which is what keeps the pillow from drifting while the rest is fastened.
The pillow is in the way because it is holding an angle. The Lahey protocol, citing Millett and colleagues in the Journal of the American Academy of Orthopaedic Surgeons, describes the safest resting position after rotator cuff repair as 30 degrees of elevation in the scapular plane with 0 to 60 degrees of external rotation, “which can be attained with the abduction sling”. Working around the wedge is the task, not removing it.
Which mistakes make the sling impossible to refit alone?
Four, and three of them happen before the arm goes in.
Standing up is the first: without a supported forearm, the unoperated hand is busy holding the arm and cannot fasten anything. Letting the elbow slip out of the corner is the second, because the straps then set the arm in the wrong position and the sling feels too big even when it fits. Leaving straps dangling is the third, which turns a short sequence into a search.
The fourth is reaching with the operated arm to speed things up. Connecticut Orthopaedics, allowing a shower from day 3, still has patients support the operated arm with the opposite hand throughout. If the sequence cannot be finished without that arm contributing, the answer is a different setup, not a stronger pull. Elbow stiffness from long spells in one position is covered separately in our guide to elbow stiffness after shoulder surgery.
When should you stop troubleshooting and ask the clinic?
When the problem is the device or the arm rather than the technique. A sling that cannot be seated after a careful seated attempt may be the wrong size or mis-assembled, and both are refits a clinic does in minutes.
The same goes for anything that changes after you fasten it: numbness, tingling or colour change in the hand, pain that climbs rather than settles, or skin under a strap that stays red. These belong at the surgeon follow-up visit, or a phone call sooner. Where your own sheet and this page disagree, your sheet wins — and our week-by-week rotator cuff sleep phases frame each phase as a question for that appointment.
Frequently asked questions
Can you put a shoulder sling back on by yourself?
North Bristol NHS Trust publishes a method for exactly that: sit down, keep the elbow at 90 degrees, support the forearm on a pillow, and slide the trough in from the side rather than from behind. The straps are then fastened in order with the unoperated hand. Whether you are cleared to have the sling off is a separate question for your surgeon.
What is the correct strap order when refitting a polysling?
Forearm strap first, about one inch below the elbow crease, then the wrist strap about one inch from the wrist. The shoulder strap goes across the back, over the unoperated shoulder and through the upper D-ring, then Velcroes onto itself. The waist strap, if prescribed, feeds through the lower D-ring and attaches over the front of the elbow section.
How do you know the sling is seated correctly?
By the finished position rather than by feel. North Bristol describes the arm held close to the front of the body, knuckles facing forwards, elbow snug in the corner of the trough, and the wrist level with or slightly higher than the elbow. The leaflet ties that wrist height to less swelling in the hand.
Why does the abduction pillow get in the way?
Because it is holding an angle. The Lahey protocol describes the safest resting position after rotator cuff repair as about 30 degrees of elevation in the scapular plane, attainable with an abduction sling. Oklahoma Shoulder Center’s refit sequence works with the pillow in place by leaning toward the operated side and buckling the waist strap early.
How many times a day will the sling come off?
It depends on the protocol. Lahey lists 4 to 5 removals a day for elbow, forearm, wrist and finger exercises, plus showering. The Stone Clinic schedules three exercise sessions a day and adds that coming out of the sling frequently to bend the elbow may limit swelling. Connecticut Orthopaedics has exercises three times a day, with showering from day 3.
Does the sling stay on at night?
The published instructions differ. Lahey says to wear the sling day and night until the end of week 6; Connecticut Orthopaedics keeps the pillow sling on at all times for three weeks, including bedtime; The Stone Clinic calls sleep wear optional depending on comfort. Ours is a reading of documents, not advice: follow your own.
Can a helper fit it the same way?
The direction changes. With a helper, North Bristol has the assistant slide the trough in from behind while you support the operated arm at 90 degrees with your other hand. Alone, the trough comes in from the side with the arm resting on a pillow.
Where to set the arm down while you work
The one thing that turns refitting from a wrestle into a sequence is a supported forearm at the right height. A counter, a table or a dense pillow on the lap all do it, as long as the forearm stays at elbow height without you holding it. This article is based on the published protocols and patient leaflets linked above, plus the maker’s production spec for each pillow named below.
If you are also rebuilding a reclined sleeping setup, our guides to the correct wedge angle after shoulder surgery and sleeping with a shoulder sling cover the same arm position after dark.
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Flexicomfort Shoulder Pillow
56 × 40 × 15 cm arm-abduction sling wedge with two adjustable straps.
See the Flexicomfort Shoulder Pillow on AmazonProducts mentioned in this guide
Aeris Wedge Pillow — 65 × 65 cm base, 22 cm apex
Flexicomfort Wedge Pillow — 60 × 56 cm base, 28 cm apex