Shoulder Dislocations
What Is a Shoulder Dislocation?
A shoulder dislocation occurs when the ball of the upper arm bone (humeral head) comes completely out of the shoulder socket (glenoid). The shoulder is the body’s most mobile joint, allowing you to reach overhead, behind your back, and across your body. Because it has such a wide range of motion, it is also the joint most likely to dislocate.
Most shoulder dislocations occur when the ball slips out the front of the socket (anterior dislocation). Less commonly, the shoulder can dislocate backward (posterior dislocation) or downward (inferior dislocation). A shoulder dislocation may also damage the labrum, rotator cuff tendons, cartilage, ligaments, nerves, or bone around the joint.
Shoulder Anatomy
The shoulder is a ball-and-socket joint made up of three bones:
- Humerus: the upper arm bone
- Scapula: the shoulder blade, which contains the shoulder socket (glenoid)
- Clavicle: the collarbone
Several important structures work together to keep the shoulder stable, including:
- The labrum, a ring of cartilage that deepens the socket
- The shoulder capsule and ligaments, which hold the joint together
- The rotator cuff muscles and tendons, which stabilize and move the shoulder
- The surrounding shoulder muscles, including the deltoid and scapular stabilizers
When a shoulder dislocates, one or more of these structures are often injured.
Causes
Shoulder dislocations commonly occur after:
- Falls onto an outstretched arm
- Contact sports such as football, hockey, wrestling, rugby, and lacrosse
- Skiing and snowboarding accidents
- Bicycle or motorcycle crashes
- Motor vehicle accidents
- Heavy lifting injuries
- Seizures or electrical injuries (often causing posterior dislocations)
Young athletes participating in contact or overhead sports have a particularly high risk of recurrent shoulder instability after an initial dislocation.
Symptoms
A shoulder dislocation typically causes:
- Sudden, severe shoulder pain
- A visible deformity or “squared off” appearance of the shoulder
- Inability to move the arm
- Swelling and bruising
- Muscle spasms
- A feeling that the shoulder has “popped out”
- Numbness or tingling in the arm or hand if nearby nerves are stretched
Some patients experience partial dislocations (subluxations), where the shoulder briefly slips out and back into place on its own.
Diagnosis
Your orthopedic specialist will carefully examine your shoulder and evaluate nerve and blood vessel function before and after the shoulder is repositioned.
Imaging studies may include:
- X-rays to confirm the dislocation and identify associated fractures
- MRI to evaluate injuries to the labrum, ligaments, cartilage, and rotator cuff
- CT scan when significant bone loss or complex fractures are suspected or for surgical planning
Early evaluation helps identify injuries that may affect long-term shoulder stability.
Common Associated Injuries
A shoulder dislocation may also cause:
- Bankart tear (tear of the labrum at the front of the shoulder)
- Hill-Sachs lesion (compression fracture of the humeral head)
- Rotator cuff tears, particularly in patients over age 40
- Glenoid (socket) fractures
- Greater tuberosity fractures
- Nerve injuries, most commonly involving the axillary nerve
- Cartilage damage that may increase the risk of arthritis later in life
Treatment Options
Treatment depends on your age, activity level, occupation, the direction of the dislocation, associated injuries, and whether this is your first or a recurrent dislocation.
Immediate Treatment
Most dislocated shoulders should be reduced (put back into place) as soon as safely possible by a trained healthcare professional.
After reduction, treatment typically includes:
- Sling immobilization
- Ice and pain medication
- Follow-up evaluation by an orthopedic specialist
- X-rays to confirm successful reduction
Do not attempt to relocate a dislocated shoulder yourself, as this can worsen injuries to bones, nerves, or blood vessels.
Non-Surgical Treatment
Many first-time shoulder dislocations can be successfully treated without surgery.
Treatment may include:
- Sling for 1-3 weeks depending on the injury
- Gradual range-of-motion exercises
- Physical therapy to restore motion, strength, and shoulder stability
- Progressive return to normal activities
Many patients recover excellent shoulder function after their first dislocation.
Surgical Treatment
Surgery may be recommended if:
- The shoulder continues to dislocate or feels unstable
- A significant labral tear is present
- There is bone loss from the humeral head or glenoid
- You participate in contact or overhead sports
- You are young and highly active
- There are associated fractures requiring repair
Arthroscopic Bankart Repair
The most common procedure for recurrent anterior instability. Through small incisions, the torn labrum and ligaments are repaired and reattached to the shoulder socket using specialized anchors.
Remplissage Procedure
When a Hill-Sachs lesion is large enough to increase the risk of recurrent instability, the remplissage procedure may be performed in addition to a Bankart repair. This arthroscopic technique fills the defect by attaching the posterior rotator cuff tendon into the indentation on the humeral head, helping prevent the shoulder from slipping out of the socket again.
Latarjet Procedure
For patients with significant bone loss or multiple recurrent dislocations, the Latarjet procedure transfers a portion of the coracoid bone to the front of the shoulder socket. This restores stability by increasing the size of the socket and adding dynamic muscular support.
Bone Grafting Procedures
In selected patients with substantial bone loss, bone grafts from either the patient or a donor may be used to reconstruct the glenoid.
Posterior Stabilization
Posterior shoulder instability may require arthroscopic repair of the posterior labrum and capsule or, less commonly, bone augmentation procedures if significant bone loss is present.
Rotator Cuff Repair
In older adults, shoulder dislocations are more commonly associated with rotator cuff tears. When necessary, rotator cuff repair may be performed at the same time as stabilization surgery.
Rehabilitation and Recovery
Recovery depends on the severity of the injury and whether surgery is required.
Non-Surgical Recovery
- Sling for approximately 1-3 weeks
- Physical therapy beginning soon after injury
- Return to normal daily activities in 6-12 weeks
- Return to contact sports usually after 3-4 months, depending on strength and stability
Recovery After Surgery
- Sling for approximately 4-6 weeks
- Early protected motion under the guidance of a physical therapist
- Progressive strengthening beginning around 8-12 weeks
- Return to non-contact sports around 4-6 months
- Return to contact or collision sports generally occurs after 6 months once strength, motion, and stability have been restored
Recovery timelines vary depending on the specific procedure performed and individual healing.
Can Shoulder Dislocations Happen Again?
Yes. The risk of recurrent dislocation depends on several factors.
Patients at highest risk include:
- Individuals younger than 25 years old
- Contact athletes
- Overhead athletes
- Patients with significant bone loss
- Individuals with generalized ligamentous laxity (loose joints)
Without surgery, recurrence rates in young athletes may exceed 70%. Early evaluation by a fellowship-trained shoulder specialist helps determine the most appropriate treatment to reduce the risk of future instability.
When Should You Seek Medical Care?
Seek immediate medical attention if you experience:
- A shoulder that appears out of place
- Severe shoulder pain after an injury
- Inability to move the arm
- Numbness or weakness in the arm or hand
- A shoulder that repeatedly slips out of place
Prompt treatment improves the chances of a successful recovery and helps prevent additional damage to the shoulder.
Why Choose Midwest Orthopedic and Musculoskeletal Alliance?
The fellowship-trained shoulder specialists at Midwest Orthopedic and Musculoskeletal Alliance provide comprehensive evaluation and treatment for both first-time and recurrent shoulder dislocations. Our team offers advanced imaging, minimally invasive arthroscopic surgery, complex shoulder stabilization procedures, and individualized rehabilitation programs designed to restore stability, relieve pain, and help patients safely return to work, athletics, and the activities they enjoy. Whether you are a competitive athlete or simply want to regain confidence in your shoulder, we are committed to providing state-of-the-art care tailored to your goals.
Get Expert Care for a Shoulder Dislocation
If you have experienced a shoulder dislocation or are suffering from shoulder instability, contact Midwest Orthopedic and Musculoskeletal Alliance today at 414-384-6700. Our orthopedic team in Southeastern Wisconsin will evaluate your condition and recommend the most appropriate treatment.