Shoulder Dislocation: Causes, Symptoms, Treatment, and Recovery

Shoulder dislocation is one of those injuries that can catch people off guard with how easily it happens and how disruptive it can be. Whether you’re an athlete, someone with an active lifestyle, or simply reached for something in an awkward way, shoulder dislocations are surprisingly common. And as a highly mobile joint, the shoulder is more prone to dislocation than other joints in the body. Understanding shoulder dislocation—why it happens, how to treat it, and what recovery looks like—can make all the difference in helping clients get back on track with confidence and safety.

In this article, we’ll explore the shoulder’s anatomy, why it’s susceptible to dislocation, and what kinds of dislocations are most common. We’ll also discuss signs and symptoms, immediate care, treatment options, and what to expect from recovery.

The Anatomy of the Shoulder and Why It’s Prone to Dislocation

The shoulder is an incredibly complex joint, known for its remarkable range of motion. It’s a ball-and-socket joint, which means it allows movement in multiple directions—lifting, rotating, extending, and more. The head of the humerus (upper arm bone) sits in the glenoid cavity of the scapula (shoulder blade), forming the glenohumeral joint. Think of it as a golf ball sitting on a tee; this design allows flexibility but also makes the joint less stable than, say, the hip joint, which has a much deeper socket.

To keep the shoulder stable, we rely on a network of muscles, tendons, and ligaments, especially the rotator cuff muscles that surround the joint and the glenoid labrum, a ring of cartilage that helps deepen the socket slightly. But because the shoulder is built more for mobility than stability, it doesn’t take a lot for the humeral head to slip out of place. This “slip” is what we call a dislocation, and it happens when external forces push or pull the joint out of its normal position.

Dislocations are usually caused by a sudden impact or a forceful movement. In sports, shoulder dislocations often occur from falls, tackles, or awkward arm positions during activities like football, basketball, or gymnastics. Outside of sports, they’re common in falls or incidents where someone might reach out to break a fall and place excessive strain on the shoulder joint.

The most common type of shoulder dislocation is an anterior dislocation, where the humeral head moves forward out of the joint. This is due to the anatomy of the shoulder, as the front of the joint capsule is generally more susceptible to stretching and tearing than the back. Posterior dislocations, where the humeral head moves backward, are less common and usually happen as a result of trauma or specific movements, like a fall with an outstretched hand.

Types of Shoulder Dislocations

Shoulder dislocations are categorized by the direction in which the humeral head moves relative to the glenoid. Anterior dislocations are the most common, making up about 95% of cases. Posterior dislocations are less frequent, while inferior dislocations—where the humeral head moves downward—are rare and typically associated with complex trauma.

Anterior dislocations occur when the arm is in a position of abduction and external rotation, such as when a person falls backward onto an outstretched arm or during high-impact sports. This position places stress on the front of the shoulder joint, stretching or tearing the capsule and ligaments that help keep the humeral head in place. This type of dislocation often damages the anterior structures of the shoulder, such as the labrum, resulting in conditions like a Bankart lesion.

Posterior dislocations, though less common, can happen from trauma or a sudden force directed on the front of the shoulder. These are sometimes seen in sports that involve heavy contact or in situations where a strong force, like an electrical shock or seizure, causes the muscles to contract forcefully. Due to their rarity, posterior dislocations are sometimes misdiagnosed, which can delay proper treatment.

Inferior dislocations, also known as luxatio erecta, are rare but particularly severe, as they usually involve nerve and vascular damage. In these cases, the arm often appears permanently raised, or "stuck" overhead, and requires immediate medical attention.

Signs and Symptoms of Shoulder Dislocation

Recognizing a shoulder dislocation isn’t too difficult, as it’s usually quite painful and often accompanied by a visible deformity. When a dislocation occurs, there is often an immediate “pop” or feeling of the joint shifting out of place. Pain is usually intense, and movement becomes extremely limited. In cases of anterior dislocation, the shoulder may look squared off rather than rounded, and the humeral head can sometimes be felt under the skin near the front of the shoulder.

Swelling and bruising are common after a dislocation and can worsen in the hours following the injury. Clients may also experience numbness or tingling down the arm due to compression or stretching of the nerves around the shoulder, such as the axillary nerve. Weakness in the arm and difficulty with basic movements like lifting or rotating are common, and some clients may experience muscle spasms as the muscles surrounding the joint attempt to stabilize the shoulder.

It’s worth noting that once someone has experienced a shoulder dislocation, they’re at a much higher risk for future dislocations. The structures of the shoulder are often weakened or damaged after the initial injury, especially if the dislocation wasn’t treated properly or if the client returned to activity too quickly.

Initial Care for Shoulder Dislocation: What to Do and What Not to Do

If you’re present when someone dislocates their shoulder, the best thing to do is to keep the person as calm and comfortable as possible until they receive medical attention. Try to avoid moving the arm or shoulder, as this can cause further damage. Stabilizing the arm with a sling or simply supporting it against the body can help relieve some pain.

It’s generally not recommended to try to relocate or “pop” the shoulder back into place on your own, as improper techniques can worsen the injury. Medical professionals use specific techniques and sometimes sedation to ensure the joint is relocated safely and without additional harm. Getting an X-ray before attempting reduction is also important, as it rules out any fractures or complications that could be aggravated by the relocation process.

Once the shoulder is back in place, immediate care usually involves rest, ice, and anti-inflammatory medications to control pain and swelling. Keeping the shoulder immobilized in a sling or brace for a short period can help the joint heal and give the surrounding tissues time to settle.

Treatment Options for Shoulder Dislocation

After the initial care and reduction, the treatment plan for shoulder dislocation depends on factors like the severity of the injury, the client’s activity level, and whether any structural damage is present. For first-time dislocations, conservative management is often the go-to approach, particularly if there’s no significant damage to the ligaments or labrum.

Physical therapy is a cornerstone of shoulder dislocation recovery, focusing on restoring strength, stability, and range of motion. In the early stages of rehab, exercises are aimed at gentle, pain-free movements to prevent stiffness and keep blood flowing to the joint. As pain subsides, the program shifts to strengthening the rotator cuff, scapular stabilizers, and other muscles that support the shoulder. Strengthening these muscles can help reduce the risk of future dislocations, as they provide the shoulder with a stronger foundation and improved stability.

For individuals with recurring shoulder dislocations or severe ligament damage, surgery might be recommended to restore stability to the joint. The most common surgical procedure is a Bankart repair, which involves reattaching the torn labrum to the glenoid, effectively deepening the socket and improving stability. Other surgical options include capsular tightening, where the joint capsule is tightened to prevent excessive movement, or a Latarjet procedure, where a portion of bone from the shoulder blade is moved to help stabilize the joint. Surgery is generally followed by a course of physical therapy to help clients regain full function and minimize the risk of re-injury.

Recovery and Rehabilitation After a Shoulder Dislocation

Recovering from a shoulder dislocation is a gradual process, and patience is key. In the first few weeks post-injury, the focus is typically on controlling pain and inflammation while maintaining gentle, passive range of motion. This helps prevent stiffness and adhesions from forming, making the later stages of rehab easier and more effective.

After about two to four weeks, clients usually progress to more active range of motion exercises, still keeping the movements within a comfortable range. Exercises at this stage might include assisted arm raises, gentle rotations, and movements that help the scapula stay in sync with the arm. Avoiding overhead movements and high-resistance exercises is important until the shoulder is more stable.

Strengthening becomes the focus in the next phase, typically around six to eight weeks after the injury, depending on the client’s comfort and recovery speed. Strengthening the rotator cuff and scapular muscles is essential, as these muscles work together to stabilize the shoulder. Exercises like internal and external rotations with resistance bands, scapular retractions, and eventually, controlled weight-bearing exercises are helpful in building stability and strength.

It’s not uncommon for clients to feel hesitant or nervous about moving the shoulder during recovery, especially if they’ve had repeated dislocations. Educating clients about the importance of gradual progression and good form can help ease these concerns. Working closely with a therapist and having a structured plan can give clients the confidence to engage in movements safely. With time, clients generally regain full function and are able to return to their usual activities, though for athletes or individuals with high-demand shoulder needs, it might take longer to reach a pre-injury level.

Preventing Recurrent Shoulder Dislocations

After experiencing a dislocation, clients are more prone to future dislocations. Fortunately, preventive measures can significantly reduce this risk. Strengthening the rotator cuff and scapular muscles is one of the most effective ways to build shoulder stability and prevent re-injury. Exercises targeting the rotator cuff, like external rotations and rows, help reinforce the structures that keep the humeral head in the glenoid socket.

Improving scapular stability is also crucial, as the shoulder blade plays a central role in shoulder mechanics. Exercises that strengthen the rhomboids, trapezius, and serratus anterior improve scapular control, allowing the shoulder joint to move smoothly. Functional exercises that involve controlled movements, like overhead presses or shoulder raises, help train the shoulder for everyday tasks and athletic demands.

Postural awareness is also beneficial, as poor posture can increase strain on the shoulder joint and make it more susceptible to injury. Simple adjustments like keeping the shoulders back and avoiding slouched positions help keep the shoulder in its natural alignment, reducing the risk of dislocation.

In some cases, clients with a history of shoulder dislocation may benefit from using supportive taping techniques or wearing a shoulder brace during high-risk activities. Taping provides a gentle reminder for clients to be mindful of their shoulder positioning, while bracing offers extra stability in situations where unexpected movements or impacts are likely.

Final Thoughts on Shoulder Dislocation

Shoulder dislocation is a challenging injury, not just for the pain and functional limitations it causes, but also for the psychological impact it can have on clients. The fear of dislocation or injury can sometimes linger long after the shoulder is physically healed, affecting the client’s confidence in their movements. As therapists and trainers, we have an important role in guiding clients through their recovery, not only by helping them regain strength and stability but also by providing them with the knowledge and support to move forward without fear.

Whether a client is recovering from a first-time dislocation or managing a history of recurrent injuries, a structured approach that includes rest, rehabilitation, and preventive measures is essential. With the right care, most clients can recover fully and return to their daily activities and sports. By addressing both the physical and mental aspects of recovery, we can help clients achieve lasting results and get back to the active, pain-free lives they enjoy.

References

• Kuhn, J. E. (2009). "A systematic review of shoulder rehabilitation exercises and an evidence-based rehabilitation protocol." Journal of Shoulder and Elbow Surgery.
• Owens, B. D., et al. (2009). "Incidence of shoulder dislocation in the United States military: Demographic considerations from a high-risk population." Journal of Bone and Joint Surgery, American Volume.
• Bankart, A. S. B. (1923). "Recurrent or habitual dislocation of the shoulder-joint."