Sleeping in Shoulder Sling After Rotator Cuff Surgery

How to Sleep After Rotator Cuff Surgery (Doctor’s 10 Tips)

by
Dr-Babar-Naeem.

This article was written by Dr. Babar Naeem (MBBS, MRCPCH) – a licensed and practicing medical doctor – to ensure maximum factual accuracy and unique content.

I will soon be having surgery on my rotator cuff to repair some damage after an overuse injury through boxing and lifting weights (potentially with a biceps tenodesis surgery to follow).

I’ve already had two arthroscopies on my right knee (with one pending for my left knee) to remove torn cartilage – so I know just how difficult it is to get to sleep after musculoskeletal surgery.

So how can you sleep better after rotator cuff surgery?

The best way to sleep better after rotator cuff surgery is to treat the acute pain with anti-inflammatory medications and ice; sleeping on your back with the affected arm elevated; sleeping on an incline to reduce shoulder pressure; and rehab to improve recovery and reduce pain long term.

The rest of this article expands on these points to give you 10 actionable ways to sleep better after rotator cuff surgery.

Although this article was written by a qualified and practising medical doctor, you should only take action under the guidance of your own surgeon or another qualified medical professional in order to avoid complications.

Related: see the best adjustable beds to help with back and shoulder pain here.

10 Ways to Sleep Better After Rotator Cuff Surgery

Research conducted at Rothman Institute of Orthopaedic Surgery, USA, revealed that sleep disturbance is very common after rotator cuff surgery.

Even 6 months after the surgery, 38% of patients still experience sleep problems.[1]

Here are 10 ways to help you sleep better after rotator cuff surgery:

1: Wear a Sling While Sleeping to Prevent Painful Movements

Sleeping With A Sling After Rotator Cuff Surgery

Wearing a sling whilst sleeping after rotator cuff surgery can help to stabilize the shoulder, prevent any sudden painful movements, and allow the shoulder to heal.

You can see how to lie comfortably on your side and back with a sling on in the video above.

Orthopedic surgeons recommend wearing a sling after rotator cuff surgery during the day.

Most of the pain and sleep disturbance is caused by the movement of the shoulder, so I always recommend my patients wear the sling during the day and the night.

A sling performs many functions, like realigning the scapula’s symmetry, supporting the forearm in the flexed position, improving anatomic alignment with an auxiliary support, and providing support to the shoulder with a cuff.

It has also been shown to decrease energy consumption while walking [2].

A sling is typically used for four to six weeks after rotator cuff surgery, but it can be removed to bathe, dress, and perform exercises – provided your arm is supported.

A recently published study revealed that wearing a sling prevents the re-tearing of the rotator cuff, and is essential for long-term healing [3].

It prevents accidental rolling over onto the affected arm at night.

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2: Sleep On Your Back With the Affected Arm Elevated

The best position to sleep in after rotator cuff surgery is on your back with the arm elevated – or on the unaffected side if you cannot sleep on your back – in order to reduce the pain and discomfort.

Elevating the affected arm by placing a pillow underneath it increases blood flow to the surrounding area, that supplies necessary nutrients, and helps in the recovery.

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3: Elevate the Upper Body to Reduce Shoulder Pressure

In addition to sleeping on your back, elevating the upper portion of an adjustable bed, or inclining your upper body with pillows can help to reduce the pressure on your shoulder to reduce pain.

This position should be used for at least four to six weeks after rotator cuff surgery.

Many patients report that they find it less painful and more comfortable to sleep in a recliner.

It helps in achieving the desired position of 45 degrees, and it offers a comfortable alternative for side and back sleepers.

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4: Prop Up Your Affected Arm With Pillows to Prevent Numbness

Elevating the affected arm will improve blood circulation and prevent numbness.

It also prevents unconsciously placing the arm in an uncomfortable position.

The best way to elevate the arm is by placing pillows or cushions underneath it.

Try these 10 ways to sleep better with upper back pain.

5: Build a Pillow Fort to Prevent Rolling Over

Rolling over on to your damaged shoulder may cause pain that can wake you up.

The best way to avoid this problem is to place a physical barrier, such as stacked pillows, next to your hips to prevent turning.

Soft pillows are better than firm pillows, as they are more comfortable, and provide a cushion effect.

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6: Follow Post-Surgery Aftercare

Post-surgery aftercare can help to speed up your recovery, reduce pain, and allow you to return to a normal sleep routine.

Follow these recommendations to speed up your recovery:

  • Wear loose-fitting clothing.
  • Shoes, shirts, and bras should be easy to wear and remove.
  • Wash your wound daily, or as directed by your doctor.
  • Dry your wound before applying a new dressing.
  • Don’t soak your wound in the water for a long time.
  • Eat a healthy diet.
  • Avoid driving for at least six weeks.
  • Don’t resume physical activity too soon, or without discussing it with your surgeon.
  • If you experience any sign of complications from the surgery, like fever, yellowish discharge, numbness, or severe pain, you should immediately contact your doctor.

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7: Use Ice Therapy to Reduce Pain and Inflammation

Applying ice or a cold compress to the affected shoulder before going to bed can reduce pain and inflammation.

Ice has been used for the management of acute and chronic musculoskeletal pain for many decades.

The application of ice causes the constriction of the blood vessels in the skin that results in numbness.

Transmission of pain signals is decreased from the cooled area [4].

To use cold therapy effectively, follow these steps:

  • Sit comfortably on a chair, and remove your shirt.
  • Wrap an ice pack in a towel.
  • Place the wrapped ice pack on your shoulder, and hold for 5-10 minutes. If you feel uncomfortable, you can remove it earlier.
  • Do not apply the ice directly on the shoulder.
  • If ice is not available, frozen vegetables can be used instead.

There are specialized cold therapy units available on the market that are very easy to use.

They fit around the shoulder like a belt and provide relief from the pain.

Many patients report that this investment is worth it because it aids sleep after rotator cuff surgery.

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8: Take Doctor-Prescribed Anti-Inflammatory Medication

Taking an anti-inflammatory medicine before bed can help to reduce the pain after your rotator cuff surgery.

A study conducted in Switzerland revealed that most patients experience severe pain within the first 48 hours after surgery [5].

During any surgery, various tissues are manipulated or cut, which results in pain.

This pain interferes with routine activities and sleep.

Pain medication is necessary at the start of the rehabilitation period and should be used as prescribed by your doctor.

A good strategy is to take a long-acting medicine at night, to allow you to sleep through.

Antibiotics are also required to stop superimposed infections.

Certain medications can also interfere with sleep, so always discuss your prescribed medicines with a doctor.

Many types of pain medicine can be prescribed after surgery; some of them are:

  • Non-Steroidal Anti-Inflammatory Drugs – are medicines that decrease fever, pain, and inflammation. Examples include Aspirin, Ibuprofen, and Naproxen. Side effects include stomach ulcers, bleeding, and kidney damage.
  • Opioids – are a class of drugs that provide a variety of effects, including pain relief. They can cause dependence, tolerance, respiratory depression, and sedation. They should be used for the shortest possible period.
  • Local Anesthetics – numb the painful area, and provide pain relief. Examples include lidocaine, bupivacaine, and prilocaine.

9: Know the Three Stages of the Recovery Process

It is necessary to have complete knowledge of the different stages of the rehabilitation process so that you can have a clear idea of what to expect during this time.

It can provide reassurance that it is normal to have sleeping problems after surgery, and will help you resolve them, with a little extra effort.

It would be best if you discussed the different stages with your surgeon and a physiotherapist, and there are three important ones to understand:

  • The first phase – is the immobilization phase, in which a sling is applied to stabilize the shoulder for a few weeks. Physical activities should be avoided during this phase, as they can inhibit the healing process.
  • The second phase – is a period in which passive exercises should be started. Isometric exercises are the best ones to perform during this phase.
  • The third phase – is the least intense of all, and you should start active exercise during this time. You can practice gentle stretching, and weight lifting exercises in this period.

You should be given detailed information about the recovery time after the surgery.

Although I recommend extreme caution for the first 4-6 weeks, the recovery period differs for each person.

It also depends upon the nature of the surgery.

For example, if you have a minor repair of the rotator cuff muscles, you may not require a sling, and complete recovery can be expected within a few weeks.

On the other hand, complicated operations, like arthroscopic surgery, can take months to recover from.

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10: Start Physiotherapy to Regain Strength and Reduce Pain

You should consult a physiotherapist and a doctor, so you can start an exercise program to help your rehabilitation as soon as is appropriate.

This is necessary to prevent stiffness and to increase the range of movement so that you can lie comfortably on the shoulder at night.

This will speed up the recovery process, providing a permanent cure to your pain and sleep problems [6].

Here are some of the exercises that your physio may prescribe – they should ONLY be carried out under professional guidance, doing them too soon may cause further damage to the shoulder and more pain:

Isometric Exercises:

Initially, it would help if you could start some exercises in which the muscle contracts, but doesn’t move.

These exercises are called isometric exercises.

They improve blood flow to the muscles, and prevent atrophy.

Research has shown that if the arm is immobilized for 5-6 weeks, then 33% of the muscle fibers and 41% of the strength of the muscle is lost [7].

As the movement of the shoulder is not possible due to surgery, the best available option in the early rehabilitation phase is isometric exercise.

You can follow these steps to do an isometric exercise:

  • Press the outside of your forearm against a wall by keeping your elbow at 90 degrees, or apply a belt around your chest and arm so that your arm is fixed.
  • Contract the muscle of your arm without moving the shoulder.
  • Hold the contracted position for 5 seconds, and then release.
  • Repeat five times.

Regular Exercises:

These should be started after the isometric exercises.

These are essential to restoring flexibility, and for full recovery after the surgery.

The recommended schedule is 2-3 sessions of 15 minutes a day.

The following exercises are recommended to speed up the rehabilitation process:

Shoulder Elevation:

  • Sit down on a comfortable chair.
  • Lift your affected arm above your head while keeping the elbow straight.
  • Maintain this posture for 15 seconds, and then bring it back down.
  • If you feel any pain or discomfort, discontinue the exercise.
  • Gradually increase the time of arm elevation as your stamina builds.
  • Repeat these steps 10-15 times.
  • Perform 3 sessions a day.

Flexion and Extension:

  • Sit down comfortably on a chair.
  • Extend your affected arm in front of you with your palm facing upward.
  • Flex your elbow, and gently raise the forearm to your shoulder.
  • Relax your arm and then repeat these steps 5 times.

Neck Flexion:

  • Sit down on a chair with your head in a neutral and comfortable position.
  • Flex your head towards the left side, and maintain this position for 10 seconds.
  • Bring your head back to the neutral position.
  • Now repeat this with the right side.
  • Perform 3 sessions of 5 minutes a day.

There are a variety of exercises available that can be used after consulting your doctor.

You should increase the intensity of exercises gradually.

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Conclusion: Treat Pain First – Then Focus on Mobility

Pain and sleep disturbance is widespread after rotator cuff surgery.

The best way to improve sleep is by sleeping in an upright position, or on the unaffected side, by placing pillows behind the back.

Pain medication and ice therapy should be applied to minimize the pain.

A physiotherapy program is essential to speed up recovery and regain full function.

Up next: 7 ways to sleep better with a frozen shoulder.

Sources and References:

[1] L. Austin et al., “Sleep Disturbance Associated With Rotator Cuff Tear: Correction With Arthroscopic Rotator Cuff Repair,” Am. J. Sports Med., vol. 43, no. 6, pp. 1455–1459, Mar. 2015, doi: 10.1177/0363546515572769.

[2] S. H. Han et al., “The effect of an arm sling on energy consumption while walking in hemiplegic patients: a randomized comparison,” Clin. Rehabil., vol. 25, no. 1, pp. 36–42, Jan. 2011, doi: 10.1177/0269215510381167.

[3] I.-H. Jeon and E. Kholinne, “To sling or not to sling the shoulder after rotator cuff repair: which side are you on?,” Ann. Transl. Med., vol. 8, no. 15, p. 972, Aug. 2020, doi: 10.21037/atm.2020.03.197.

[4] E. Ernst and V. Fialka, Ice freezes pain? A review of the clinical effectiveness of analgesic cold therapy,” J. Pain Symptom Manage., vol. 9, no. 1, pp. 56–59, 1994, doi: https://doi.org/10.1016/0885-3924(94)90150-3.

[5] A. P. Boss, T. Maurer, S. Seiler, A. Aeschbach, B. Hintermann, and S. Strebel, “Continuous subacromial bupivacaine infusion for postoperative analgesia after open acromioplasty and rotator cuff repair: Preliminary results,” J. Shoulder Elb. Surg., vol. 13, no. 6, pp. 630–634, Nov. 2004, doi: 10.1016/j.jse.2004.04.005.

[6] C. Jung et al., “Rehabilitation following rotator cuff repair: A work of the Commission Rehabilitation of the German Society of Shoulder and Elbow Surgery e. V. (DVSE) in collaboration with the German Association for Physiotherapy (ZVK) e. V., the Association Physical Therapy, Association for Physical Professions (VPT) e. V. and the Section Rehabilitation-Physical Therapy of the German Society for Orthopaedics and Trauma e. V. (DGOU),” Obere Extrem., vol. 13, no. 1, pp. 45–61, 2018, doi: 10.1007/s11678-018-0448-2.

[7] J. R. S. J D MacDougall, G C Elder, D G Sale, J R Moroz, “Effects of strength training and immobilization on human muscle fibres,” Eur J Appl Physiol Occup Physiol, 1980, doi: 10.1007/BF00421352.

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