Shoulder dislocation

Shoulder Dislocation: How to Recognize and Treat It?

A shoulder dislocation is characterized by sudden pain, deformity, or marked difficulty moving the arm; treatment begins with an urgent evaluation and, while the shoulder is still dislocated, reduction by a healthcare professional. Recovery then depends on the type of dislocation, associated injuries, age, activities, and the chosen treatment. The American Academy of Orthopaedic Surgeons describes the evaluation, treatment, and rehabilitation.

This article explains the signs, emergency care, rehabilitation, and factors associated with new dislocations.

What is a Shoulder Dislocation?

A shoulder dislocation occurs when the head of the humerus—the upper arm bone—completely slips out of the glenoid cavity, the socket in the shoulder blade that forms the joint. The shoulder blade is a flat bone located at the top of the back. In Quebec, people often use the expression “l’épaule a débarqué” (the shoulder has come off), which is a fairly accurate description of what happens.

The shoulder joint allows for a wide range of motion. Its high degree of mobility makes movement, strength, and stability key factors in the evaluation, but it does not, on its own, predict a dislocation.

Significant deformity or limited range of motion in the arm warrants urgent evaluation. The appearance, pain, and range of motion vary depending on the dislocation and any associated injuries.

A dislocation can be anterior, when the head of the humerus dislocates forward, or posterior, when it dislocates backward. The healthcare professional assesses the injuries based on the clinical context and the physical examination.

Who is Affected by Shoulder Dislocations?

Shoulder dislocations can affect people of all ages, with varying profiles depending on the population and activities. Age, gender, and sports participation may be associated with risk in certain groups, but none of these factors alone predicts an individual’s risk.

Active young adults

The first dislocation often occurs in young, active men in certain cohorts—that is, groups of people followed in studies. This trend varies depending on the population and context. A Swedish study of people aged 18 to 70 reports a prevalence of at least 1.7% and approximately three times as many dislocations in men.¹ This study does not directly measure a peak among active young adults.

The impact of age

A recurrence is a new dislocation that occurs after the first one. The risk of recurrence varies depending on age, the extent of the injury, activities, and treatment. No percentage can predict a person’s risk with certainty.

Among adults, a review of ten studies links being 40 years old or younger to a higher rate of recurrence.² Age must be considered in conjunction with the lesions, activities, and treatment.

Athletes

Sports involving contact, falls, or repetitive overhead movements put the shoulder at risk of dislocation. The risk also depends on a person’s medical history, previous injuries, and individual characteristics.

After an initial dislocation, rehabilitation can gradually restore movement, strengthen the shoulder, and prepare the patient for a return to sports. The program is tailored to the specific injury, symptoms, and demands of the activity.

What are the Symptoms of a Shoulder Dislocation?

Symptoms of a shoulder dislocation often include sudden pain, deformity, and significant difficulty moving the arm. The severity of these symptoms varies, but a suspected dislocation requires prompt evaluation.

Some people report a sensation of displacement or a popping sound at the moment of the injury. These sensations alone do not confirm a dislocation.

The shoulder’s appearance may change, but the deformity is not always obvious. The shoulder may appear more square or lower, and an unusual lump may appear under the skin. The person may have great difficulty lifting, rotating, or extending the arm.

Signs That Warrant an Urgent Evaluation

A cold or discolored hand, numbness, or an inability to move the fingers warrants an urgent evaluation.

These signs are used to check for a problem involving the nerves or blood circulation; on their own, they do not reveal the cause.

Under what circumstances can a shoulder dislocation occur?

A shoulder dislocation can occur after a fall, a blow, a twist, or an accident. It can also occur in people with hypermobility—that is, joints that move more than average—or due to instability without any obvious trauma.

A description of the movement helps the healthcare professional understand the context. This description alone is not sufficient to determine the specific injuries present.

What factors are associated with recurrence?

Injuries following a first dislocation vary. A Bankart lesion—a tear in the labrum, the cartilaginous rim at the front of the joint—may be present, but it is not universal. A systematic review of 1,920 shoulders reported a Bankart lesion in 59 percent of shoulders following a first dislocation and in 66 percent following a recurrent dislocation.³ A medical evaluation and imaging may be indicated depending on the presentation.

Injuries to the capsule—a layer of tissue surrounding the joint—the labrum, and the bone vary following a dislocation. A Hill-Sachs lesion, a small indentation in the head of the humerus, may be observed, but its presence alone does not predict whether a person will experience a recurrence. The same review reports a Hill-Sachs lesion in 71 percent of shoulders after a first dislocation and in 85 percent after a recurrent dislocation, indicating an association with recurrence rather than an established individual predictive value based on this single measure.³

The forces and movements associated with a new dislocation vary. Some people report an episode occurring during an ordinary activity, without this indicating the same injuries or a common mechanical threshold.

The reassuring message is that your body is not defective. Recurrences depend on several factors, including age, activity level, hypermobility—that is, joints that move more than average—and certain injuries; an individualized assessment helps determine the appropriate treatment.

What to Do Immediately After a Dislocation?

If you suspect a dislocation, immobilize the arm in a comfortable position and go to the emergency room. Do not attempt to reset the shoulder yourself. A healthcare professional will determine whether an X-ray is necessary before reduction—that is, before the joint is put back into place.

If It's Your First Dislocation

A healthcare professional must perform the reduction and check for circulation, nerve function, and the possibility of a fracture. A study conducted in the emergency department involving 334 people with an anterior dislocation found a significant fracture in 25.5% of the participants. Being 40 years of age or older, a first episode, and certain injury mechanisms—including motor vehicle accidents—were associated with this risk.⁴

In Quebec, a physical therapist who holds the required certification may order certain X-rays when the official criteria are met and medical follow-up is planned.

While Awaiting Medical Care

While waiting for treatment, support your arm in a comfortable position. After the reduction, wear the sling and resume movement as directed, since injuries and needs vary. A pharmacist or doctor can advise you on medications based on your health condition and other treatments you are taking.

Practical Tips for the First Few Days

Choose a comfortable position and support according to the instructions you received.

When sleeping, choose a position that’s tolerable and provides comfortable support. Sleeping in a more upright position with pillows may be more comfortable during the first few nights. The guidelines from Cambridge University Hospitals also explain how to ensure comfort.

How Does Physiotherapy Treat a Shoulder Dislocation?

Physical therapy addresses limitations that persist after reduction by focusing on mobility, strength, control, and a return to activities. The program takes into account the patient’s injuries, medical instructions, and personal goals. Our comprehensive guide to shoulder pain also describes other issues that can affect this joint.

Phase 1: Controlled Immobilization

After reduction, a splint or sling may be used for a specific period of time, depending on your age, any associated injuries, and the medical team’s instructions. During this phase, your physical therapist will assess your range of motion and activities, introduce exercises according to the instructions provided, and teach you how to protect your shoulder.

Phase 2: Restoring Mobility

After immobilization, the physical therapist selects guided movements or manual techniques based on the patient’s stability, injuries, symptoms, and goals. The therapist also adapts the exercises—including those targeting the nerves—to the medical instructions and the patient’s response.

Phase 3: Strengthening and Stabilization

This phase aims to restore range of motion, strength, and control before a gradual return to activities. The program can strengthen the muscles of the shoulder and shoulder blade, and then gradually incorporate work- or sports-related movements. The physical therapist selects the resistance, speed, and movements based on the patient’s abilities and goals.The American Academy of Orthopaedic Surgeons describes this general progression.

Shoulder control exercises, as well as strength and endurance exercises, are tailored to the specific task at hand.

Phase 4: Return to Activities

The return to sports is planned based on the type of dislocation, the injuries, the treatment, the athlete’s abilities, and the demands of the sport. The timeline is adjusted based on the observed response.

Rehabilitation aims to improve range of motion—that is, the extent of movement—as well as strength, control, and tolerance for activities. The goals and pace of return to normal activities depend on each person’s individual situation.

Our clinic can provide an evaluation and a program tailored to your abilities and goals. Our guide also explains how physical therapy can help with shoulder pain.

Why Do Some Shoulders Dislocate Repeatedly?

Recurrences depend on several factors, including age, activities, the observed injuries, and treatment. They cannot be attributed in every case to a labral tear or persistent stretching of the capsule.

Recurrence Statistics

In the cited sources, estimates of recurrence vary depending on the population, age, and follow-up.² In the cited cohort, 44% of individuals experienced a third dislocation following the second; in this national registry study, the risk of a third dislocation did not differ statistically by age or sex.⁵

Recurrences may occur early or later; their frequency and timing vary depending on the population, the type of dislocation, the treatment, and follow-up care.

Risk Factors

In some cohorts, age, sex, joint hypermobility, and certain lesions are associated with the risk of recurrence. A meta-analysis—a study that combines the results of multiple studies—included 10 studies and 1,324 participants. It reported associations with male sex, age 40 or younger, and joint hypermobility.² These factors describe group trends and do not, on their own, predict an individual’s risk.

In the same meta-analysis, a fracture of the greater tuberosity—a bony protrusion near the top of the humerus—was associated with fewer recurrences.² The healthcare professional interprets this finding in conjunction with other injuries, activities, and the patient’s progress.

The timing of recurrence varies depending on the population, treatment, and follow-up. The time elapsed alone does not predict individual risk.

Rehabilitation can focus on mobility, strength, control, and returning to activities. The program is tailored to the specific injuries, symptoms, and target activities.

The Warning Sign

Any apprehension or sensation of slippage warrants evaluation. These symptoms alone do not indicate mechanical instability or the need for surgery.

How to Prevent Recurrent Dislocations?

Preventing recurrence may involve appropriate rehabilitation, a gradual return to activities, and a surgical consultation when warranted by the patient’s condition. These options are designed to improve function and guide decision-making. No single option guarantees that a new dislocation will not occur.

Rehabilitation Tailored to Specific Goals

Rehabilitation focuses on mobility, strength, control, and movements related to daily activities. The physical therapist tailors the program, its duration, and the exercises to the specific injuries, the chosen treatment, and the patient’s goals. No program can guarantee that another dislocation will not occur.

Smart Activity Modification

Movements are gradually reintroduced based on stability, injuries, symptoms, and goals; no specific results or timeframes are guaranteed.

Knowing When Surgery Becomes Necessary

A surgical consultation may be considered based on the number of episodes, the nature of the injuries, bone loss, the individual’s activities, response to rehabilitation, and personal preferences.

Main Surgical Options

Arthroscopic Bankart repair—a surgical procedure performed through small incisions—repairs the labrum, the rim of cartilage that has become detached at the front of the joint. The technique and its indication depend on the nature of the injury and the surgeon’s judgment. A systematic review of studies published from 2008 to 2018 reported a recurrence rate of approximately 17.4% following this surgery, but the definition of failure varied widely among the studies.⁶ This result does not predict a patient’s outcome.

After surgery, the time it takes to return to work and sports varies greatly from person to person and should be planned in consultation with the surgeon and physical therapist.

If the shoulder dislocates again, an evaluation can help determine the appropriate course of treatment, though it does not guarantee that it will not happen again. In the long term, changes visible on X-rays are more common after repeated episodes without surgery, but they can still occur even without another episode, and surgery does not appear to eliminate this risk.⁷ After 25 years of follow-up, 39 percent of shoulders that had a recurrence without surgery showed moderate to severe joint changes visible on X-rays, compared with 18 percent of shoulders without recurrence. The group treated with surgical stabilization had fewer of these changes than the group that had a recurrence without surgery.⁷

What symptoms should you watch for after a shoulder dislocation?

After a dislocation, it is especially important to monitor for fractures, nerve or circulatory damage, and injuries to the shoulder tissues. The healthcare professional selects the appropriate examination and imaging based on the symptoms. Articles on rotator cuff tears, ligament pain, and joint pain explain some of the associated conditions.

Other causes of pain may coexist following an injury. The evaluation distinguishes , in particular , between shoulder bursitis and an acromioclavicular sprain at the top of the shoulder when these diagnoses are consistent with the symptoms.

When to Consult a Professional?

After a suspected dislocation, deformity, a cold or discolored hand, numbness, or an inability to move the fingers, an urgent evaluation is warranted.

After an episode that resolved on its own or a recurrence, a medical or physical therapy evaluation may be recommended depending on the level of pain, limitations in daily activities, or nerve-related symptoms, such as numbness or weakness.

An orthopedic consultation may be considered depending on the type of instability, recurrent episodes, associated injuries, activities, goals, and preferences. The number of dislocations or the patient’s age alone is not sufficient to warrant surgery.

Physical therapy can help address the limitations that arise after a dislocation. Our guide explains how physical therapy can help manage joint pain.

How can you get help for your shoulder dislocation?

Physioactif's physical therapists can assess movement and activities following a dislocation and refer patients to a doctor when necessary. We offer programs tailored to mobility, strength, control, and individual goals.

A dislocation can limit certain activities. The Physioactif team can assess your symptoms, your range of motion, and certain factors associated with recurrences. They can then tailor your return to activities or refer you for a medical evaluation and imaging when necessary.

Sources

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1. Hovelius L. Incidence of shoulder dislocation in Sweden. Clin Orthop Relat Res. 1982(166):127-31. (Back to section: 1)
2. Olds M, Ellis R, Donaldson K, Parmar P, Kersten P. Risk factors that predispose first-time traumatic anterior shoulder dislocations to recurrent instability in adults: a systematic review and meta-analysis. Br J Sports Med. 2015;49(14):913-22. (Back to sections: 1, 2, 3, 4)
3. Rutgers C, Verweij LPE, Priester-Vink S, van Deurzen DFP, Maas M, van den Bekerom MPJ. Recurrence in traumatic anterior shoulder dislocations increases the prevalence of Hill-Sachs and Bankart lesions: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2022;30(6):2130-2140. (Back to sections: 1, 2)
4. Emond M, Le Sage N, Lavoie A, Rochette L. Clinical factors predicting fractures associated with an anterior shoulder dislocation. Acad Emerg Med. 2004;11(8):853-8. (Back to section: 1)
5. Kao JT, Chang CL, Su WR, Chang WL, Tai TW. Incidence of recurrence after shoulder dislocation: a nationwide database study. J Shoulder Elbow Surg. 2018;27(8):1519-1525. (Back to section 1)
6. Kennedy MI, Murphy C, Dornan GJ, Moatshe G, Chahla J, LaPrade RF, et al. Variability in Reporting Recurrence After Arthroscopic Bankart Repair: A Call for a Standardized Study Design. Orthop J Sports Med. 2019;7(5):2325967119846915. (Back to section: 1)
7. Hovelius L, Saeboe M. 2008 Neer Award: Arthropathy following primary anterior shoulder dislocation—223 shoulders prospectively followed up for twenty-five years. J Shoulder Elbow Surg. 2009;18(3):339-47. (Back to sections: 1, 2)
8. 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):1665-74.
9. Murthi AM, Ramirez MA. Shoulder dislocation in older patients. J Am Acad Orthop Surg. 2012;20(10):615-22.