Approximately 2% of the population will experience at least one episode of shoulder dislocation during 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 alarming, your shoulder is designed to heal. With the right treatment and appropriate rehabilitation, most people regain normal function—and there are concrete ways to significantly reduce the risk of recurrence.

You will discover why dislocations occur, how to recognize the signs that require immediate attention, and, above all, how physical therapy 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 upper arm bone) pops completely out of the glenoid cavity (the socket in the shoulder blade that forms the joint). In Quebec, we often hear the expression "the shoulder has come out"—a fairly 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:

Subluxation : The humerus partially slips out of the joint, then spontaneously returns to its normal position. You will feel a sensation of slippage or instability, followed by a return to the normal position. Complete dislocation : The humerus completely dislocates from the glenoid cavity and remains displaced. The shoulder appears deformed and cannot be put back into place without medical assistance.

In more than 95% of cases, the dislocation is anterior—that is, the humerus slips out toward the front of the joint. Posterior dislocations are much rarer and usually occur during falls with the arm outstretched or during seizures.

Who is affected by shoulder dislocations?

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

Working young adults are the most affected The first dislocation occurs in 77% of cases in men aged 20 to 35. The peak incidence is between 15 and 29 years of age, particularly in those who participate in contact sports or sports with a risk of falling. Age changes everything If you are under 20 years of age when you first dislocate your shoulder, your risk of recurrence is 80 to 90%. Between the ages of 20 and 40, this risk decreases to about 60%. After age 40, it drops to only 10 to 15%.

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

Athletes are on the front line Sports such as hockey, football, volleyball, gymnastics, and rock climbing pose a high risk. Any activity involving contact, possible 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 is clear: invest in comprehensive rehabilitation to prevent your shoulder from repeatedly "popping out."

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.

Sudden, intense pain The pain strikes at the moment of injury and remains very present. Unlike other injuries that gradually worsen, dislocation hurts from the very first second. Feeling of "popping" or dislocation When the shoulder dislocates, you may hear or feel a distinct pop, followed by a very clear sensation that something is wrong. Visible deformation of the shoulder By comparing your two shoulders, you will notice that the dislocated shoulder looks different. The shoulder may appear more square, lower, or the bone may create an unusual bump under the skin. Complete inability to move the arm You cannot raise your arm, rotate it, or move it away from your body. Even small movements are impossible or extremely painful.

Emergency signs that should never be ignored

Go to the emergency room if you notice:

• Numbness or loss of sensation in the arm, hand, or fingers that persists or worsens
• Inability to move fingers or hand that does not improve
• Coldness or discoloration of the hand or fingers (sign of a circulatory problem)
• Significant weakness in the arm that does not correspond to the 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.

Now that you know how to recognize a dislocation, let's look at what actually causes it—and why some people seem more vulnerable than others.

What REALLY causes a shoulder dislocation?

The myth : "I have a weak shoulder" or "My shoulder is fragile." Reality When you dislocate your shoulder for the first time, it's not that your shoulder is weak—it's that the force of the trauma exceeds the resistance capacity of any normal shoulder.

For a healthy shoulder to luxate the first time, considerable force must be applied in a vulnerable position:

• Falls with landing on an outstretched arm: The impact propels the humerus out of the glenoid cavity with a force that the ligaments cannot withstand.
• Direct contact during sports: A check in hockey, a tackle in football, or a collision in basketball
• Extreme twisting movements: The arm remains stuck while the body continues to turn.
• Car accidents: Sudden deceleration combined with the position of the arm

But then, why do some shoulders dislocate repeatedly?

This is where things change. After an initial dislocation, structural damage occurs:

Bankart lesion The labrum (a ring of cartilage that deepens the glenoid cavity) tears, often accompanied by a tear in the ligaments that stabilize the front of the shoulder. It's as if the rim that prevented the ball from coming off the tee is now broken. Stretching of the joint capsule The membrane surrounding the joint becomes stretched. Even after healing, it remains looser than before, reducing natural stability. Hill-Sachs lesion : The head of the humerus may become slightly deformed as it exits the joint, creating a small bone depression that facilitates future dislocations.

Once this damage is present, it does not take a major traumatic force for the shoulder to dislocate again. Some people report that their shoulder simply "pops out" when putting on a coat, throwing a ball, or rolling over in bed.

The liberating message: Your body is not defective. Recurrent dislocations are the predictable consequence of specific structural damage—and that 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 this is your first dislocation: Go to the emergency room.

Never attempt to reset the shoulder yourself. Reduction (resetting) must be performed by a healthcare professional, and here's why:

• An X-ray is essential to rule out a fracture before reduction.
• Approximately 25% of first dislocations are accompanied by small fractures.
• Improper technique can worsen damage to nerves, vessels, or bones.

Did you know? 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 acronym PEACE (you can find more details in our comprehensive guide to shoulder pain):

P - Protection : Secure the arm against the body. Use a scarf, triangular bandage, or even your other hand to hold the arm in a comfortable position. E - Elevation Keep your arm supported—don't let it hang down. A - Avoid anti-inflammatory drugs Avoid anti-inflammatory drugs for the first 48 hours. Tylenol (acetaminophen) is acceptable for pain relief. C - Compression : Can be used with caution, but immobilization is more significant. E - Education : Understand your injury and follow the appropriate medical advice.

Practical tips for the first few days

To reduce pain :

• Support your arm with a pillow under your armpit.
• Place your hand in your pants pocket to relieve the weight on your shoulder.
• Use an armrest if you are at a desk.

To sleep :

• Ensure your neck is well supported with a pillow.
• Keep your arm alongside your body or supported by a pillow.
• Avoid sleeping on the injured shoulder.
• Never sleep with your arm behind your head.

With these first steps in place, let's see how physical therapy can speed up your recovery and prevent recurrence.

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 when physical therapy becomes your best ally in regaining a functional and stable shoulder.

Phase 1: Controlled immobilization (0-3 weeks)

Immediately after reduction, your shoulder will be immobilized with a splint or sling for 2 to 3 weeks.

During this phase, your physical therapist assesses the integrity of your structures, introduces "pendulum" movements to maintain a minimum of mobility, and teaches joint protection.

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

Once the immobilization is removed, the real work begins:

• Joint mobilization: The physical therapist gently guides your shoulder in different directions, gradually restoring range of motion.
• Active-assisted exercises: You begin to move your shoulder actively, but with assistance.
• Nerve slides: 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:

• Strengthening the rotator cuff: These four deep muscles are the main stabilizers of the shoulder.
• Scapular stabilization: The shoulder blade must be stable for the shoulder to function properly.
• Neuromuscular control: Your shoulder must relearn how to stabilize itself instinctively.
• Plyometric exercises: For athletes, explosive exercises prepare the shoulder for the demands of sport.

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 physical therapy programs for shoulder pain that can guide you through each phase of your rehabilitation.

But even with the best rehabilitation, some shoulders continue to dislocate. Let's see why.

Why do some shoulders dislocate repeatedly?

If your shoulder has "popped out" a second time, you're probably wondering, "Why me? Will this continue forever?"

The answer depends on several factors—some you can control, others you cannot.

Thought-provoking figures

The statistics on recidivism are sobering:

• If you are under 20 years of age: 80 to 90% risk of recurrence
• Between 20 and 40 years of age: Risk of recurrence approximately 60%
• After 40 years: 10 to 15% risk of recurrence
• After a second dislocation: The risk of a third dislocation increases 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

Factors you cannot change :

• Age at the time of the first dislocation: The younger you are, the more elastic your tissues are and the less they "heal tightly."
• Male gender: Men have a three times higher risk of recurrence.
• Hyperlaxity: Naturally "loose" joints increase the risk by 2.7 times.

Factors you can influence :

• Quality of rehabilitation: Completing a structured program significantly reduces the risk of recidivism.
• Respecting recovery times: Returning to sports too quickly dramatically increases the risk.
• Sustained muscle strengthening: Maintaining optimal strength creates a "muscular armor."
• Changes in activities: Avoiding extreme positions preserves stability

The warning sign: Apprehension and instability

If you develop a constant fear that your shoulder will dislocate in certain positions (called "apprehension"), or if you regularly feel that your shoulder is "slipping" or "wanting to pop out," these are signs of real instability that warrant surgical evaluation.

The good news: There are solutions to break this cycle.

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.

Strategy 1: Comprehensive and intensive rehabilitation

Rehabilitation is not optional—it is your first line of defense.

Complete the entire program People who drop out of rehabilitation halfway through have much higher recidivism rates. Continue beyond the official end : Continuing strengthening exercises 2 to 3 times a week for an additional 6 to 12 months creates lasting protection. Incorporate functional exercises Don't just stick to exercises with resistance bands. Incorporate movements that resemble your sport or daily activities.

Strategy 2: Smart modification of activities

You don't have to give up sports—but you may need to adapt.

Identify your risk positions Most people with recurrent instability know exactly which movements are dangerous. Avoid these positions at the beginning of rehabilitation : Give your tissues time to heal before challenging them. Reintroduce gradually With reinforcement, you may eventually recover these positions—but it takes time.

Strategy 3: Knowing when surgery becomes necessary

Surgery is not a failure—sometimes it's the smartest solution.

Indications for considering surgery :

• You have had two or more complete dislocations despite serious rehabilitation efforts.
• Your shoulder subluxates regularly (several times a month).
• You are under 25-30 years old and participate in high-level contact sports.
• Imaging shows a significant Bankart lesion or significant bone loss.
• Your quality of life is seriously affected by the constant fear that your shoulder will dislocate.

The main surgical options : Arthroscopic Bankart procedure The surgeon reattaches the labrum and tightens the ligaments using small anchors. Success rate of 85 to 95%. Latarjet procedure : In cases involving significant bone loss in the glenoid cavity, the surgeon transfers a bone fragment to create a "stop" that prevents the humerus from dislocating. Post-surgical recovery time :

• Immobilization: 3 to 6 weeks
• Return to office work: 2 to 4 weeks
• Return to physical work: 3 to 4 months
• Return to non-contact sports: 4 to 6 months
• Return to contact sports: 6 to 12 months

The key message

Recurrent dislocations are not inevitable. With intensive rehabilitation, smart changes to your activities, and surgery when indicated, you can regain a stable shoulder that allows you to live life to the fullest.

The key is to act proactively rather than passively endure dislocations. Each additional dislocation increases the damage—so don't let the situation worsen without taking action.

When should you consult a professional?

Go to the emergency room immediately. if:

• This is your first shoulder dislocation.
• You have persistent numbness in your arm or hand
• Your hand or fingers are cold or discolored
• You cannot move your fingers

Consult a doctor or physical therapist promptly. if:

• You had a dislocation that popped back into place on its own (subluxation).
• Your shoulder has dislocated repeatedly and you want to explore your options.
• You have already had a dislocation and are developing instability or apprehension.

Consult an orthopedic surgeon if:

• You have had two or more complete dislocations.
• Your shoulder regularly subluxates.
• You are young and active with a first dislocation (to discuss preventive surgery)

Physical therapists in Quebec have the expertise to assess your shoulder, order X-rays if necessary, and refer you to the best treatment option for your specific situation.