Shoulder Dislocation.
What is a shoulder dislocation?
A shoulder dislocation occurs when the head of the humerus — the ball of the shoulder joint — is forced out of the glenoid socket. The glenohumeral joint is the most mobile joint in the body, which makes it inherently the most unstable and the most frequently dislocated major joint — accounting for approximately 45% of all large joint dislocations.
The vast majority of shoulder dislocations are anterior — the humeral head displaces forward and downward out of the glenoid, typically from a force applied to the arm with the shoulder in abduction and external rotation. This is the classic mechanism of a rugby tackle, a football collision, a fall from a surfboard or a cricket wicket-keeping injury. Posterior dislocation is less common and can be caused by seizures, electrocution or motor vehicle accidents — it is frequently missed on initial assessment because the shoulder appears relatively normal externally, and a high index of suspicion with appropriate imaging is required.
What structures are damaged?
A first-time anterior shoulder dislocation almost always tears the anterior labrum and the medial glenohumeral ligament — the Bankart lesion — as the humeral head forces its way out through the anterior capsulolabral complex. Bony damage is also common: a Hill-Sachs lesion — a dent on the posterior humeral head from impaction against the glenoid rim — occurs in approximately 70% of first-time dislocations, and a bony Bankart lesion — a fracture of the anterior glenoid rim — occurs in approximately 25%. These bony defects have significant implications for recurrence risk and the surgery versus conservative management decision.
Additional associated injuries include axillary nerve injury — producing temporary or permanent numbness and deltoid weakness — and rotator cuff tears, particularly in older adults where the cuff is more vulnerable to the traction and impaction forces of dislocation.
The recurrence problem — why the first dislocation matters so much
The most important clinical fact about shoulder dislocation is the recurrence risk — and it is directly related to age at first dislocation. In patients under 25, recurrence rates after conservative management alone are approximately 60 to 90%. In patients over 40, recurrence rates fall to approximately 15 to 20% — reflecting the trade-off between increasingly tight and inelastic capsular tissue in older adults and the growing likelihood of associated rotator cuff tears.
This means the management decision after a first-time dislocation is critically different depending on the patient's age and activity level. A 20-year-old contact sport athlete has a very high probability of re-dislocation without surgery and should have an early surgical consultation — ideally before returning to sport. A 55-year-old who dislocates while falling in the garden has a much lower recurrence risk and is well managed conservatively with physiotherapy.
How is it diagnosed and what happens immediately?
Clinical history and physical examination are often enough to make an accurate diagnosis in uncomplicated cases. Your physiotherapist or emergency physician will assess your shoulder's range of motion and pain levels. Imaging — an X-ray or MRI — can be used to confirm the diagnosis and check for any fractures or damage to the surrounding tissues.
Reduction — returning the humeral head to the glenoid socket — is performed by a doctor in the emergency department. Post-reduction X-ray confirms the position. MRI — ideally MRI arthrography — provides the most comprehensive assessment of the labral and capsular damage and guides the management decision.
How can physiotherapy help?
Physiotherapy is the foundation of conservative management and an essential component of the post-surgical pathway when surgery is chosen.
An acutely dislocated shoulder requires a period of rest and immobilisation to allow the joint surrounding tissues to heal and reduce laxity. The duration and position of immobilisation is debated — traditionally three to six weeks in a sling — but the evidence now favours earlier mobilisation (within one to two weeks) rather than prolonged immobilisation, which produces significant stiffness without meaningfully reducing recurrence risk in younger patients.
Pain management using hands-on techniques, cold packs and TENS controls pain and swelling in the acute phase. Mobilisation techniques restore full range of motion in the shoulder. Strengthening exercises targeting the muscles around the shoulder prevent future dislocations and improve stability.
The rotator cuff and periscapular muscles are the primary rehabilitation targets — building the dynamic stability that compensates for the damaged passive restraints. Specifically, infraspinatus and teres minor strengthening for external rotation — the position of maximum dislocation vulnerability — and subscapularis strengthening are the priority exercises. Scapular stabiliser rehabilitation — lower trapezius, serratus anterior — restores the scapular control that positions the glenoid correctly during arm elevation.
Proprioceptive retraining — rebuilding the shoulder's position sense and neuromuscular response to perturbation — is critically important after dislocation, as the mechanoreceptors in the torn capsulolabral tissue are permanently damaged and the shoulder's reflexive protective response must be retrained through exercise.
Proprioception exercises can help improve shoulder stability and significantly reduce the risk of shoulder injuries and recurrent dislocations. A physiotherapy protocol that includes strengthening of shoulder and scapular musculatures, proprioceptive exercises, and plyometric exercises for developing agility — all combined with taping for the shoulder joint — helps stabilise the shoulder and normalises muscle function.
For patients who proceed to shoulder reconstruction surgery — Bankart repair, Latarjet or capsular shift — post-surgical physiotherapy follows the specific rehabilitation protocol for the procedure performed. For patients with chronic or recurrent shoulder instability, see our glenohumeral joint instability page.
For patients whose dislocation occurred in a workplace or motor vehicle accident, WorkCover and CTP funded physiotherapy is available.
Our physiotherapists Bethany Kippen and Yulia Khasyanova both have experience in shoulder conditions and are members of the Australian Physiotherapy Association. Mauricio Bara's APA Sports Physiotherapist credentials are particularly relevant for sporting shoulder dislocation presentations where the return-to-contact-sport decision is critical.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
A shoulder dislocation occurs when the head of the humerus — the ball of the shoulder joint — is forced out of the glenoid socket. The glenohumeral joint is the most mobile joint in the body, which makes it inherently the most unstable and the most frequently dislocated major joint — accounting for approximately 45% of all large joint dislocations.
The vast majority of shoulder dislocations are anterior — the humeral head displaces forward and downward out of the glenoid, typically from a force applied to the arm with the shoulder in abduction and external rotation. This is the classic mechanism of a rugby tackle, a football collision, a fall from a surfboard or a cricket wicket-keeping injury. Posterior dislocation is less common and can be caused by seizures, electrocution or motor vehicle accidents — it is frequently missed on initial assessment because the shoulder appears relatively normal externally, and a high index of suspicion with appropriate imaging is required.
What structures are damaged?
A first-time anterior shoulder dislocation almost always tears the anterior labrum and the medial glenohumeral ligament — the Bankart lesion — as the humeral head forces its way out through the anterior capsulolabral complex. Bony damage is also common: a Hill-Sachs lesion — a dent on the posterior humeral head from impaction against the glenoid rim — occurs in approximately 70% of first-time dislocations, and a bony Bankart lesion — a fracture of the anterior glenoid rim — occurs in approximately 25%. These bony defects have significant implications for recurrence risk and the surgery versus conservative management decision.
Additional associated injuries include axillary nerve injury — producing temporary or permanent numbness and deltoid weakness — and rotator cuff tears, particularly in older adults where the cuff is more vulnerable to the traction and impaction forces of dislocation.
The recurrence problem — why the first dislocation matters so much
The most important clinical fact about shoulder dislocation is the recurrence risk — and it is directly related to age at first dislocation. In patients under 25, recurrence rates after conservative management alone are approximately 60 to 90%. In patients over 40, recurrence rates fall to approximately 15 to 20% — reflecting the trade-off between increasingly tight and inelastic capsular tissue in older adults and the growing likelihood of associated rotator cuff tears.
This means the management decision after a first-time dislocation is critically different depending on the patient's age and activity level. A 20-year-old contact sport athlete has a very high probability of re-dislocation without surgery and should have an early surgical consultation — ideally before returning to sport. A 55-year-old who dislocates while falling in the garden has a much lower recurrence risk and is well managed conservatively with physiotherapy.
How is it diagnosed and what happens immediately?
Clinical history and physical examination are often enough to make an accurate diagnosis in uncomplicated cases. Your physiotherapist or emergency physician will assess your shoulder's range of motion and pain levels. Imaging — an X-ray or MRI — can be used to confirm the diagnosis and check for any fractures or damage to the surrounding tissues.
Reduction — returning the humeral head to the glenoid socket — is performed by a doctor in the emergency department. Post-reduction X-ray confirms the position. MRI — ideally MRI arthrography — provides the most comprehensive assessment of the labral and capsular damage and guides the management decision.
How can physiotherapy help?
Physiotherapy is the foundation of conservative management and an essential component of the post-surgical pathway when surgery is chosen.
An acutely dislocated shoulder requires a period of rest and immobilisation to allow the joint surrounding tissues to heal and reduce laxity. The duration and position of immobilisation is debated — traditionally three to six weeks in a sling — but the evidence now favours earlier mobilisation (within one to two weeks) rather than prolonged immobilisation, which produces significant stiffness without meaningfully reducing recurrence risk in younger patients.
Pain management using hands-on techniques, cold packs and TENS controls pain and swelling in the acute phase. Mobilisation techniques restore full range of motion in the shoulder. Strengthening exercises targeting the muscles around the shoulder prevent future dislocations and improve stability.
The rotator cuff and periscapular muscles are the primary rehabilitation targets — building the dynamic stability that compensates for the damaged passive restraints. Specifically, infraspinatus and teres minor strengthening for external rotation — the position of maximum dislocation vulnerability — and subscapularis strengthening are the priority exercises. Scapular stabiliser rehabilitation — lower trapezius, serratus anterior — restores the scapular control that positions the glenoid correctly during arm elevation.
Proprioceptive retraining — rebuilding the shoulder's position sense and neuromuscular response to perturbation — is critically important after dislocation, as the mechanoreceptors in the torn capsulolabral tissue are permanently damaged and the shoulder's reflexive protective response must be retrained through exercise.
Proprioception exercises can help improve shoulder stability and significantly reduce the risk of shoulder injuries and recurrent dislocations. A physiotherapy protocol that includes strengthening of shoulder and scapular musculatures, proprioceptive exercises, and plyometric exercises for developing agility — all combined with taping for the shoulder joint — helps stabilise the shoulder and normalises muscle function.
For patients who proceed to shoulder reconstruction surgery — Bankart repair, Latarjet or capsular shift — post-surgical physiotherapy follows the specific rehabilitation protocol for the procedure performed. For patients with chronic or recurrent shoulder instability, see our glenohumeral joint instability page.
For patients whose dislocation occurred in a workplace or motor vehicle accident, WorkCover and CTP funded physiotherapy is available.
Our physiotherapists Bethany Kippen and Yulia Khasyanova both have experience in shoulder conditions and are members of the Australian Physiotherapy Association. Mauricio Bara's APA Sports Physiotherapist credentials are particularly relevant for sporting shoulder dislocation presentations where the return-to-contact-sport decision is critical.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
