Shoulder Dislocation: Prevention, Treatment & Rehabilitation

What Happens in a Shoulder Dislocation?

A shoulder dislocation occurs when the humeral head is displaced out of the glenoid socket. In 95% of cases, the dislocation is anterior (the humeral head moves forward). It is the most commonly dislocated major joint in the body, accounting for around 50% of all joint dislocations.

How It Happens

The shoulder joint trades stability for mobility, its very shallow socket allows an enormous range of movement but also makes it vulnerable to dislocation. Anterior dislocations typically occur when the arm is forced into an abducted, externally rotated position, such as tackling in football or falling on an outstretched arm. Sports, falls, and road trauma are common causes.

Initial Management

A dislocated shoulder should be relocated as soon as possible, under adequate sedation or anaesthesia. This is most commonly done in an emergency department. X-rays are taken before and after relocation to confirm the diagnosis and check for associated fractures.

Associated Injuries

Most shoulder dislocations result in a tear of the anterior labrum and inferior glenohumeral ligament, called a Bankart lesion. A bony Bankart lesion involves a chip of glenoid bone. A Hill-Sachs lesion (compression fracture of the posterior humeral head) is also common.

Who Needs Surgery?

Re-dislocation rates after a first dislocation are strongly age-dependent: approximately 90% in patients under 20, declining with age. For young, active patients, particularly athletes, early surgical stabilisation (Bankart repair) is increasingly recommended after a first traumatic dislocation. For older or less active patients, physiotherapy-guided rehabilitation is the first-line approach.

Surgical Stabilisation

Arthroscopic Bankart repair involves reattaching the torn labrum and tightening the inferior glenohumeral ligament. It is a keyhole procedure with a small incision and typically performed as a day case. Recovery involves a sling for 4–6 weeks and physiotherapy over 4–6 months. Return to contact sport is typically 6–9 months post-operatively.

In patients with significant glenoid bone loss, a bony reconstruction procedure (Latarjet) may be recommended rather than soft tissue repair.

Further Reading

Dr Yu has written in more detail about this topic on his own site: shoulder instability and shoulder stabilisation surgery.