Shoulder Dislocation: Causes, Symptoms & Recovery

A shoulder dislocation is one of the most common major joint dislocations, and if it has happened to you, you know how painful and alarming it can be. The good news is that with the right treatment and rehabilitation, most people recover well. However, you should understand the risk of the shoulder dislocating again and what you can do to prevent it.

This article explains what a shoulder dislocation is, what causes it, how it is treated, and what recovery involves.

What Is a Shoulder Dislocation?

The shoulder is a ball-and-socket joint. The ball (head of the humerus, or upper arm bone) sits in a shallow socket (the glenoid) on the shoulder blade. Unlike the hip, the shoulder socket is relatively shallow, which gives the shoulder its remarkable range of movement but also makes it the most commonly dislocated large joint in the body.  1

A dislocation occurs when the ball is forced completely out of the socket.

• Anterior dislocation (forwards): By far the most common type, accounting for approximately 95–97% of cases. The ball displaces forwards and inwards.
• Posterior dislocation (backwards): Much less common; often associated with seizures or electric shock.
• Inferior dislocation (luxatio erecta): Very rare.

What Causes a Shoulder Dislocation?

In Sport

The most common cause is a force applied to the arm when it is raised and rotated outwards, for example:

• Tackling or falling in football, rugby, or kabaddi with the arm outstretched
• A fall onto an outstretched hand
• A blow to the shoulder from an opponent or the ground
• Throwing-related mechanisms in overhead sports

Outside Sport

• Falls from height or during everyday activities
• Road traffic accidents
• Seizures (which can cause posterior dislocations due to muscle spasm)

What Happens to the Shoulder During a Dislocation?

When the shoulder dislocates, more than just the joint surfaces are affected. The surrounding structures are commonly damaged at the same time:

• Bankart lesion: A tear of the labrum, the cartilage ring around the socket that deepens it and provides stability. This is the most common associated injury, seen in up to 85% of first-time dislocations. 2
• Hill-Sachs lesion: A dent or compression fracture on the back of the ball of the shoulder where it impacts the socket rim.
• Rotator cuff tear: More common in dislocations that occur in older patients (over 40 years).
• Nerve injury: The axillary nerve, which runs close to the shoulder joint, can be stretched during a dislocation, causing temporary numbness over the outer upper arm.
• Bony Bankart lesion: A fracture of the front rim of the socket, which has important implications for treatment.

Symptoms of a Shoulder Dislocation

• Severe shoulder pain: often described as one of the most painful experiences
• Obvious deformity: the shoulder looks "squared off" rather than rounded; there may be a visible bump below the collarbone
• Loss of normal movement; the arm is usually held protectively by the side
• Numbness or tingling in the arm, hand, or the area below the shoulder suggesting nerve involvement

Immediate Management: Getting the Shoulder Back In

A dislocated shoulder needs to be relocated (reduced) as soon as possible by a trained medical professional. Patients or bystanders should not attempt this, as incorrect technique can worsen injuries to bone, blood vessels, or nerves.

Relocation is performed in an emergency setting, usually with pain relief and muscle relaxation (Entonox, analgesia, or procedural sedation). Clinicians use several techniques, depending on the patient and the clinical situation. 3

After relocation, an X-ray confirms the joint is back in the correct position and checks for any associated fractures.

What Happens After the Shoulder Is Relocated?

Immediate Care

• The arm is placed in a sling for comfort, usually for 2-4 weeks, depending on the injury severity and the patient's age and activity level.
• Ice and anti-inflammatory medication help with pain and swelling

The Critical Question: Will It Happen Again?

The most important factor to understand after a first-time dislocation is the risk of recurrence. The shoulder is at significantly higher risk of dislocating again, particularly in young, active individuals:

• In patients under 20 years old, the recurrence rate is reported to be as high as 70- 90% following non-surgical treatment alone.  4
• In patients aged 20-40, the recurrence rate is approximately 50-60%
• In older patients (over 40), the risk is lower, but rotator cuff tears become a greater concern

This high recurrence rate is why managing a first-time dislocation in a young athlete requires careful discussion, as the choice between physiotherapy alone and early surgical stabilisation can significantly affect long-term shoulder health.

Physiotherapy and Rehabilitation

Whether or not surgery is required, physiotherapy plays a central role in recovery.

Rehabilitation focuses on:

1. Restoring range of motion gently and progressively after the sling period
2. Strengthening the rotator cuff muscles, which act as dynamic stabilisers of the shoulder
3. Scapular stabilisation exercises: the shoulder blade must move correctly for the shoulder joint to function safely
4. Proprioceptive training re-educates the joint's position sense, which is disrupted after a dislocation
5. Sport-specific rehabilitation in the later stages before return to play 5

When Is Surgery Recommended?

Surgery is typically discussed in the following situations:

• Recurrent dislocation; the shoulder has dislocated two or more times
• First-time dislocation in a young athlete who participates in a high-demand or contact sport, where the recurrence risk is very high
• Associated structural damage, particularly a significant bony Bankart lesion (bone loss from the socket rim), which makes the shoulder inherently less stable
• Failure of adequate rehabilitation to restore stability

Surgical Options

Arthroscopic Bankart repair: The most common procedure for soft-tissue instability. Using keyhole (arthroscopic) techniques, the torn labrum is reattached to the socket rim with suture anchors, restoring socket depth and stability. 6

Latarjet procedure (bone-block procedure): Recommended when there is significant bone loss from the front of the socket. A piece of bone from the coracoid process is transferred to the front of the socket to rebuild the rim and create a bony and muscular sling effect. This procedure has excellent long-term outcomes for recurrent instability with bone loss. 7

Recovery After Shoulder Stabilisation Surgery

Recovery timelines vary based on the procedure performed:

Key Takeaways

• A shoulder dislocation occurs when the ball is forced out of the socket, usually forwards.
• Young, active individuals have a very high risk of the shoulder dislocating again after a first episode.
• Associated injuries, particularly a Bankart lesion, are common and affect long-term shoulder stability.
• Physiotherapy is essential for all patients; surgery is recommended in those with recurrent instability or significant bone loss.
• With appropriate treatment and rehabilitation, most people return fully to sport and daily activities.

If you have experienced a shoulder dislocation, particularly more than once, a proper assessment by a shoulder specialist is important to understand your individual risk and the most appropriate management.

References

1. Zacchilli MA, Owens BD. "Epidemiology of shoulder dislocations presenting to emergency departments in the United States." Journal of Bone and Joint Surgery. 2010;92(3):542–549. https://doi.org/10.2106/JBJS.I.00450
2. Bankart ASB. "The pathology and treatment of recurrent dislocation of the shoulder joint." British Journal of Surgery. 1938;26(101):23–29. https://doi.org/10.1002/bjs.1800260104
3. Hendey GW. "Managing anterior shoulder dislocation." Annals of Emergency Medicine. 2016;67(1):76–80. https://doi.org/10.1016/j.annemergmed.2015.05.002
4. Hovelius L, et al. "Nonoperative treatment of primary anterior shoulder dislocation in patients forty years of age and younger: a prospective twenty-five-year follow-up." Journal of Bone and Joint Surgery. 2008;90(5):945–952. https://doi.org/10.2106/JBJS.G.00070
5. Wilk KE, Macrina LC. "Non-operative and post-operative rehabilitation for glenohumeral instability." Clinics in Sports Medicine. 2013;32(4):865–914. https://doi.org/10.1016/j.csm.2013.07.015
6. Mohtadi NGH, et al. "Arthroscopic versus open repair for traumatic anterior shoulder instability: a meta-analysis." Arthroscopy. 2005;21(6):652–658. https://doi.org/10.1016/j.arthro.2005.02.021
7. Bessière C, et al. "The open Latarjet procedure is more reliable in terms of shoulder stability than arthroscopic Bankart repair." Clinical Orthopaedics and Related Research. 2014;472(8):2345–2351. https://doi.org/10.1007/s11999-014-3550-9