Advanced shoulder sling: Integrating versatile features into a triangular bandage.

This study created an orthosis with several functions in addition to the triangular bandage. The triangular bandage positioned the forearm forward, suspended the arm from the neck, and secured the arm from the neck to the wrist. The design was modified from this limb position. Phase 1: Shoulder rotation was changed from extreme internal rotation to 30 degree internal rotation, Kapandji's physiological reference position (flexion/extension, 0 degree; abduction/adduction, 0 degree; rotation, 30 degree internal rotation position), allowing for the partial use of the hand. Phase 2: The sling knot position was changed from the neck to above the ipsilateral shoulder to avoid neck pain. Phase 3: A sling with elbow pads and straps replaced the Velcro to prevent the knot from loosening. Phase 4: To prevent the shoulder straps of the sling from being pulled off by the forearm during external shoulder rotation, the twisted straps pass through the shoulder and forearm loops. Phase 5: Additional straps around the shoulder and axilla were placed outward to prevent the straps from falling off due to scapular movement. Because the humeral head is rotated 30 degree posteriorly, immobilization in the 30 degree internal rotation position of the shoulder joint improves scapulohumeral joint conformity and achieves rotator cuff equilibrium. Suspension from the ipsilateral shoulder also counteracts gravity and reduces the load on intrinsic muscles such as the rotator cuff. Allowing anterior-posterior pendulum motion not only stabilizes the trunk but can also be used for early range-of-motion training. The sling has evolved as an immobilization and a suspension device.