Shoulder dislocation

Shoulder Dislocation: A Complete Guide to Understanding and Treating This Injury

Approximately 2% of the population will experience at least one shoulder dislocation in their lifetime, and this injury accounts for nearly 50% of all joint dislocations. Here's the good news: even though a shoulder dislocation is painful and concerning, your shoulder is designed to heal. With the right treatment and proper rehabilitation, most people regain normal function, and there are concrete ways to significantly reduce the risk of recurrence.

For a quick overview of this condition and our treatment services, please visit our shoulder dislocation page. This in-depth guide will help you understand why dislocations happen, how to recognize signs that require immediate attention, and most importantly, how physiotherapy can help you regain a stable and functional shoulder.

What is a shoulder dislocation?

A shoulder dislocation occurs when the head of the humerus (the arm bone) completely comes out of the glenoid (the socket of the shoulder blade that forms the joint). In Quebec, you often hear the expression "l'épaule a débarqué" (the shoulder came off), which is a rather accurate description of what happens.

The shoulder joint functions like a golf ball placed on a tee: it allows extraordinary mobility in all directions, but this freedom of movement also makes it more vulnerable to dislocation than any other large joint in the body.

There are two distinct situations to understand. Subluxation occurs when the humerus partially comes out of the joint, then spontaneously returns to its place. You will feel a sensation of slipping or instability, followed by a return to normal position. A complete dislocation occurs when the humerus fully comes out of the glenoid and remains displaced. The shoulder takes on a deformed appearance and cannot return to its place without medical assistance.

In over 95% of cases, the dislocation is anterior, meaning the humerus moves forward out of the joint. Posterior dislocations are much rarer and generally occur during falls with the arm extended forward or during seizures.

Who is affected by shoulder dislocations?

Shoulder dislocations do not affect everyone equally. Certain profiles are at much greater risk.

Active young adults

The first dislocation occurs in 77% of cases among men aged 20 to 35. The peak incidence is between 15 and 29 years old, particularly among those who play contact sports or sports with a risk of falling.

The impact of age

The age at the time of the first dislocation changes everything for the prognosis. If you are under 20 years old at the time of your first dislocation, your risk of recurrence reaches 80 to 90%. Between 20 and 40 years old, this risk decreases to about 60%. After 40 years old, it drops to only 10 to 15%.

This dramatic difference is explained by several factors: tissues are more elastic in young people, which promotes recurrence; activity levels are generally higher; and young people have more years ahead of them to be exposed to new risky situations.

Athletes

Athletes are particularly susceptible to shoulder dislocations. Sports like hockey, football, volleyball, gymnastics, and climbing carry a high risk. Any activity involving contact, potential falls, or rapid overhead arm movements increases vulnerability.

If you recognize yourself in one of these profiles and have just experienced your first dislocation, your priority becomes clear: invest in comprehensive rehabilitation to prevent your shoulder from repeatedly dislocating.

What are the symptoms of a dislocated shoulder?

A shoulder dislocation does not go unnoticed. The symptoms are usually obvious and appear immediately after the injury.

Intense and sudden pain occurs at the moment of injury and persists. Unlike other injuries that worsen gradually, a dislocation hurts from the very first second. When the shoulder dislocates, you might hear or feel a distinct pop or clunk, followed by a very clear sensation that something is wrong.

Comparing your two shoulders, you will notice that the dislocated one has a different appearance with a visible deformity. The shoulder may appear more squared off, lower, or the bone might create an unusual bump under the skin. You cannot lift your arm, rotate it, or move it away from your body. Even small movements are impossible or extremely painful.

Emergency Signs to Never Ignore

Go to the emergency room if you notice numbness or loss of sensation in your arm, hand, or fingers that persists or worsens, an inability to move your fingers or hand that doesn't improve, coldness or discoloration of your hand or fingers (a sign of a circulatory problem), or significant arm weakness that doesn't match the level of pain.

These signs may indicate nerve or vascular damage that requires urgent intervention. Nerves and blood vessels run very close to the shoulder joint and can be stretched or compressed during a dislocation.

What Really Causes a Shoulder Dislocation?

The popular myth is "I have a weak shoulder" or "My shoulder is fragile." The reality is different: during a first dislocation, it's not your shoulder that's weak; it's the force of the trauma that exceeds the resistance capacity of any normal shoulder.

For a healthy shoulder to dislocate for the first time, considerable force must be applied in a vulnerable position. Falls where you land on an outstretched arm can force the humerus out of the socket with a strength that ligaments cannot withstand. Direct impacts during sports like a hockey check, a football tackle, or a basketball collision can cause a dislocation. Extreme twisting movements where the arm gets caught while the body continues to turn, and car accidents with sudden deceleration combined with the arm's position are also common causes.

Why do some shoulders dislocate repeatedly?

After a first dislocation, structural damage occurs that changes the situation. A Bankart lesion means that the labrum, a ring of cartilage that deepens the socket, tears, often accompanied by a tearing away of the ligaments that stabilize the front of the shoulder. It's as if the rim that kept the ball from falling off the tee is now broken.

Stretching of the joint capsule means that the envelope surrounding the joint becomes distended. Even after healing, it remains looser than before, reducing natural stability. A Hill-Sachs lesion means that the head of the humerus can deform slightly when it comes out of the joint, creating a small bone indentation that makes future dislocations easier.

Once this damage is present, it no longer takes a major traumatic force for the shoulder to dislocate again. Some people report that their shoulder dislocates simply by putting on a coat, throwing a ball, or turning over in bed.

The liberating message is that your body is not defective. Recurrent dislocations are the predictable consequence of specific structural damage, and this damage can be treated.

What should you do immediately after a dislocation?

The first few hours after a dislocation are crucial. Your immediate actions will influence your recovery and your risk of complications.

If It's Your First Dislocation

Never attempt to put the shoulder back in place yourself; go to the emergency room. The reduction must be performed by a healthcare professional because an X-ray is essential to rule out a fracture before the reduction. Approximately 25% of first dislocations are accompanied by small fractures, and an improper technique can worsen damage to nerves, blood vessels, or bones.

In Quebec, physical therapists can order X-rays if the injury occurred less than 72 hours ago. If you do not have quick access to a doctor, a physical therapist can refer you and order the necessary imaging.

While waiting for medical care

The first phase of management follows the PEACE protocol. Protect the shoulder by immobilizing the arm against the body. Use a sling, a triangular bandage, or even your other hand to keep the arm in a comfortable position. Keep the arm supported and do not let it hang. Avoid anti-inflammatory medications during the first 48 hours. Tylenol (acetaminophen) is acceptable for pain. Compression can be used with caution, but immobilization is more important. Understand your injury and follow appropriate medical advice.

Practical tips for the first few days

To reduce pain, support your arm with a cushion under your armpit, place your hand in your pants pocket to relieve weight from your shoulder, and use an armrest if you are at a desk.

To sleep, ensure your neck is well-supported with a pillow, keep your arm along your body or supported by a pillow, avoid sleeping on the injured shoulder, and never sleep with your arm behind your head.

How does physical therapy treat a shoulder dislocation?

After a doctor has put your shoulder back in place, the real rehabilitation begins, and that's where physiotherapy becomes your best ally for regaining a functional and stable shoulder. Our complete guide to shoulder pain offers more details on the different conditions that can affect this joint.

Phase 1: Controlled immobilization (0-3 weeks)

Immediately after the reduction, your shoulder will be immobilized with a brace or sling for 2 to 3 weeks. During this phase, your physiotherapist assesses the integrity of your structures, introduces pendulum exercises to maintain a minimum of mobility, and teaches joint protection.

Phase 2: Restoration of mobility (3-6 weeks)

Once immobilization is removed, the real work begins with joint mobilizations and manipulations. The physiotherapist gently guides your shoulder in different directions, gradually restoring range of motion. Active-assisted exercises allow you to start moving your shoulder actively but with assistance. Nerve glides are specific exercises that gently mobilize the nerves in the arm.

Phase 3: Strengthening and stabilization (6-12 weeks)

This is the most critical phase for preventing recurrence. Rotator cuff strengthening targets these four deep muscles that are the main stabilizers of the shoulder. Scapular stabilization ensures that the shoulder blade is stable for the shoulder to function correctly. Neuromuscular control allows your shoulder to relearn how to stabilize instinctively. Plyometric exercises prepare athletes' shoulders for explosive sports demands.

Stabilizer muscle exercises and muscle strengthening and endurance exercises are an integral part of this crucial phase.

Phase 4: Return to activities (3-6 months)

The typical time frame for returning to sports is 3 to 6 months, depending on the sport and your progress. For some contact sports, this time frame can extend to 6 to 12 months if surgery was necessary.

With comprehensive and well-monitored rehabilitation, most people regain normal range of motion, sufficient strength for daily activities and sports, and stability that allows them to safely return to their activities.

Our clinic offers specialized physiotherapy programs for shoulder pain that can guide you through each phase of this rehabilitation.

Why do some shoulders dislocate repeatedly?

If your shoulder has dislocated a second time, you're probably wondering why and if it will continue. The answer depends on several factors, some you can control and others you cannot.

Recurrence Statistics

The statistics are sobering. If you are under 20, the risk of recurrence reaches 80 to 90%. Between 20 and 40, this risk decreases to about 60%. After 40, it drops to only 10 to 15%. After a second dislocation, the risk of a third climbs to 44%, regardless of your age.

Even more troubling, the majority of recurrences occur within the first two years after the initial injury.

Risk factors

Among the factors you cannot change, age at the time of the first dislocation plays a major role because the younger you are, the more elastic your tissues are and the less tightly they heal. Being male presents a 3 times higher risk of recurrence. Hypermobility, where joints are naturally loose, increases the risk by 2.7 times.

Among the factors you can influence, the quality of your rehabilitation is paramount, as completing a structured program significantly reduces the risk of recurrence. Respecting healing timelines is crucial because returning to sports too quickly dramatically increases the risk. Consistent muscle strengthening builds a protective 'muscle armor.' Adjusting activities to avoid extreme positions helps maintain stability.

The Warning Sign

If you develop a constant fear that your shoulder might dislocate in certain positions (known as apprehension), or if you regularly feel your shoulder slipping or wanting to come out, these are signs of true instability that require a surgical evaluation.

How can recurrent dislocations be prevented?

If you have already experienced one or more dislocations, your goal becomes clear: prevent it from happening again. Here are some strategies that work.

Complete and Intensive Rehabilitation

Rehabilitation is not optional; it's your first line of defense. Make sure to complete the entire program, as individuals who stop their rehabilitation halfway through have significantly higher recurrence rates. Continue beyond the official completion by doing strengthening exercises 2 to 3 times a week for an additional 6 to 12 months; this builds lasting protection. Incorporate functional exercises and don't just stick to exercises with resistance bands. Include movements that mimic your sport or daily activities.

Smart Activity Modification

You don't necessarily have to give up sports, but you might need to make some adjustments. Identify your at-risk positions, as most people with recurring instability know exactly which movements are dangerous. Avoid these positions early in your rehabilitation to allow your tissues time to heal before challenging them. Gradually reintroduce these movements, as with strengthening, you can eventually regain these positions, but it will take time.

Knowing When Surgery Becomes Necessary

Surgery is not a sign of failure; sometimes, it's the smartest solution. Reasons to consider surgery include having experienced two or more complete dislocations despite serious rehabilitation, a shoulder that regularly subluxes multiple times a month, being under 25-30 years old and participating in high-level contact sports, imaging that reveals a significant Bankart lesion or substantial bone loss, and a quality of life severely impacted by the constant fear of shoulder dislocation.

The main surgical options

Arthroscopic Bankart surgery allows the surgeon to reattach the labrum and tighten the ligaments using small anchors, with a success rate of 85% to 95%. Latarjet surgery is recommended for cases with significant bone loss in the glenoid, where the surgeon transfers a bone fragment to create a block that helps prevent the humerus from dislocating.

Post-surgical recovery timelines typically involve 3 to 6 weeks of immobilization, 2 to 4 weeks for returning to office work, 3 to 4 months for returning to physical labor, 4 to 6 months for returning to non-contact sports, and 6 to 12 months for returning to contact sports.

The key takeaway is that recurrent dislocations are not inevitable. With a combination of intensive rehabilitation, smart activity modifications, and surgery when appropriate, you can regain a stable shoulder that allows you to live life to the fullest. The key is to act proactively rather than passively enduring dislocations. Each additional dislocation increases the damage, so don't let the situation worsen without taking action.

Associated Conditions to Watch For

A shoulder dislocation can sometimes come with other injuries or conditions that are important to be aware of. Injuries related to ligament pain can affect the shoulder's supporting structures. Chronic joint pain may develop if rehabilitation is not fully completed. Rotator cuff injuries can also occur with a dislocation, especially in individuals over 40.

Shoulder bursitis and shoulder sprain are conditions that can coexist with post-dislocation instability and should be assessed as part of a complete evaluation.

When should you consult a professional?

Seek immediate emergency care if this is your first shoulder dislocation, if you experience persistent numbness in your arm or hand, if your hand or fingers are cold or discolored, or if you cannot move your fingers.

Consult a doctor or physiotherapist promptly if you've experienced a dislocation that reduced on its own (subluxation), if your shoulder has dislocated repeatedly and you wish to explore your options, or if you've had a previous dislocation and are now developing instability or apprehension.

Consult an orthopedic surgeon if you've experienced two or more complete dislocations, if your shoulder regularly subluxes, or if you are young and active with a first dislocation and wish to discuss preventive surgery.

Physiotherapists in Quebec have the expertise to assess your shoulder, prescribe X-rays if needed, and guide you toward the best treatment option for your specific situation. Physiotherapy for joint pain provides a comprehensive approach to treating the effects of a dislocation.

Getting Help for Your Shoulder Dislocation

Our physiotherapists at Physioactif specialize in assessing and treating shoulder dislocations and instability. We develop personalized programs to restore your shoulder's stability and help prevent future dislocations.

Don't let a shoulder dislocation limit your life or sports activities. Contact Physioactif to schedule your comprehensive evaluation. Our experienced team will assess the extent of the damage, identify your risk factors for recurrence, and develop an individualized treatment plan to help you regain a stable and functional shoulder.

Sources

Kavaja L, Pajarinen J, Sinisaari I, et al. Arthrosis of glenohumeral joint after arthroscopic Bankart repair: a long-term follow-up of 13 years. J Shoulder Elbow Surg. 2012;21(3):350-355.

Hovelius L, Saeboe M. Neer Award 2008: Arthropathy after primary anterior shoulder dislocation. J Shoulder Elbow Surg. 2009;18(3):339-347.

Owens BD, Duffey ML, Nelson BJ, DeBerardino TM, Taylor DC, Mountcastle SB. The incidence and characteristics of shoulder instability at the United States Military Academy. Am J Sports Med. 2007;35(7):1168-1173.

Sachs RA, Lin D, Stone ML, Paxton E, Kuney M. Can the need for future surgery for acute traumatic anterior shoulder dislocation be predicted? J Bone Joint Surg Am. 2007;89(8):1665-1674.

Itoi E, Hatakeyama Y, Sato T, et al. Immobilization in external rotation after shoulder dislocation reduces the risk of recurrence. J Bone Joint Surg Am. 2007;89(10):2124-2131.