EPISODE 67: Shoulder Dislocations: Diagnosis & Rehab Explained

By Dr. Silverton Nguyen & Dr. Ja'nae Brown

The shoulder is one of the most mobile joints in the body—far more flexible than other “ball-and-socket” joints like the hip. The unique design allows us to perform a wide range of movements, from scratching our backs to throwing a baseball, while still being strong enough for lifting weights or carrying groceries.

That mobility is a strength—but it also comes with a high risk of injury. In this blog post, we are going to discuss shoulder dislocations and the road to recovery if you get injured and dislocate your shoulder.

What Is a Shoulder Dislocation?

Shoulder dislocations are one of the most common injuries we see at PTSP and in sports.

A shoulder dislocation occurs when the head of the humerus (ball) is forced out of the glenoid (socket) of the scapula.

There are 3 types of shoulder dislocations:

• Anterior dislocation (most common ~90%): the ball moves forward

• Posterior dislocation (less common): the ball moves backward (often from seizures or electrical injuries)

• Inferior dislocation (rare): the arm is forced overhead and the ball shifts downward

Why the Shoulder Is Vulnerable?

A big reason the shoulder is so vulnerable is due to the shoulder’s shallow structure. The socket does not fully cover the ball—it's more like a golf ball sitting on a tee. For this reason, it is important for the shoulder to have stabilizing structures to support it.

Some of the key stabilizing structures in the shoulder include:

• Labrum: deepens the socket

• Capsule & ligaments: provide passive stability

• Rotator cuff: dynamic stabilizers keeping the ball centered

• Scapular muscles: control shoulder blade positioning

Because stability depends heavily on soft tissue, disruption to any of these increases the risk of dislocation or instability.

Let's go into some ways the shoulder can dislocate.

Mechanism of Injury

Shoulder dislocations account for about 50% of all major joint dislocations. That is a lot.

The most common mechanisms of injury we see in the shoulder include:

• Falling on an outstretched hand

• Direct impact to the shoulder

• Motor vehicle accidents

• Forceful twisting or overhead loading (sports)

In anterior dislocations, the arm is often in an abducted and externally rotated position (think: cocking phase of throwing). If you injured your shoulder in one of these ways, it is likely that you dislocated your shoulder.

Now let's talk about how you might know you dislocated your shoulder.

Signs and Symptoms

People who experience a dislocation often describe:

• A sudden “pop” or shifting sensation

• Immediate pain in the shoulder

• Loss of motion in the arm

• Visible deformity (shoulder appears out of place or “sunken”)

Additional findings may include:

• Muscle guarding, ie, you keep your arm close to your body

• Swelling around the shoulder

• Numbness or tingling (possible nerve involvement, commonly the Axillary nerve)

• Weakness with lifting or rotating the arm

The most important thing to do after a shoulder dislocation is to put it back in place. We call this a reduction. Let's discuss some specifics about what a reduction in and how it is done.

What Is a Reduction?

The goal after a shoulder dislocation is to return to it's normal position. This is called a reduction. A reduction may occur spontaneously. If it does not reduce on it's own it may require medical reduction in the ER. This procedure in non-invasive and is typically done by a physician through an manual technique. Even if the shoulder reduces on its own (which can occur with active movement), follow-up care is essential to rule out additional damage using imaging (X-ray, sometimes MRI). If you are a chronic dislocater, you will want a referral to a physical therapist to strengthen and stabilize you shoulder.

Associated Injuries and Complications

A shoulder dislocation rarely occurs in isolation. Often times there are additional injuries associated with it. Some of the common associated injuries include:

• Bankart lesion (labral tear)

• Bony Bankart lesion (labral tear with fracture)

• Hill-Sachs deformity (compression fracture of the humeral head)

In addition, shoulder dislocations can have other serious considerations:

• ~40% involve the axillary nerve ( the axillary nerve is the power supply and communication line to the shoulder)

• ~25% involve fractures

• Risk of recurrent dislocation: ~1–5% (higher in younger athletes)

So what can you expect if you dislocated your shoulder? Well it really depends on if you have addiitonal injuries or require surgery. Let's discuss some different scenerios.

Prognosis: What to Expect

We all want to know what to expect when we get injured. Recovery for a shoulder dislocation can depend on:

• Age

• Activity level

• Severity of tissue damage

• First-time vs recurrent dislocation

General things you can expect:

• 3–4 months to return to normal activity

• Longer for overhead athletes or contact sports

• Higher recurrence rates in younger, active individuals

Treatment Options

1. Non-Surgical Management

Appropriate for many first-time dislocations without major structural damage.

• Short period of immobilization (sling)

• Physical Therapy referral for:

  • Early guided movement

  • Progressive strengthening and stability training

  • Return to sport training

    
    

2. Surgical Management

Considered when:

• Recurrent dislocations (especially in the youth population)

• Significant labral or bony injury

• High-demand athletes

Procedures may include:

• Labral repair (Bankart repair)

• Capsular tightening

• Bone stabilization procedures

Regardless of surgical or non surgical approaches, you will end up in our office. Physical therapy is the cornerstone for getting an unstable shoulder stable. If you elect in surgery, you will need guidance post- operatively and instruction back to normal daily activities and sport. Let's take a general look this process.

Rehabilitation Process & Protocol

Rehabilitation is critical—whether surgery is performed or not and is often broken up into phases. Let's walk through them.

Phase 1: Protection & Pain Control (0–2 weeks)

• Sling (as prescribed)

• Reduce pain and inflammation

• Gentle passive range of motion by the physical therapist

  
  

Phase 2: Restore Mobility (2–6 weeks)

• Gradual increase in range of motion

• Avoid excessive external rotation (outward movement of the arm) early

• Begin light activation of rotator cuff and scapular muscles

Phase 3: Strength & Stability (6–12 weeks)

• Progressive resistance training

• Focus on rotator cuff and scapular control

• Introduce functional movement patterns

Phase 4: Advanced Strength & Return to Activity (12+ weeks)

• Plyometrics and dynamic stability

• Sport-specific drills

• Gradual return to lifting, throwing, or contact

Return-to-Sport Criteria

Before full return, patients should demonstrate:

• Symmetrical strength ( testing for this occurs in the clinic with dynamometry and force decks)

• No pain with functional movement

• Good neuromuscular control

• Ability to tolerate sport-specific load and all perform all sport specific skills

Why Physical Therapy Matters

Even if surgery isn’t required, sports physical therapy is essential to restore mobility and joint awareness, build strength and stability, reduce re-injury risk and provide a structured, progressive return to activity.

Without proper rehab, the shoulder may feel “fine”—but still lack the control needed to prevent future dislocations.

So don't skip it! An unstable shoulder will not get stable without physical therapy. Show up for your appointments, be consistent, do your home program and listen to you PT and you will get back to the things you love to do and likely come out stronger and better than before

Final Takeaways

1. The shoulder’s design allows for incredible movement—but that mobility comes with a reliance on surrounding structures for stability.

2. A shoulder dislocation is more than just a joint slipping out of place. It often involves damage to key stabilizers and requires a thoughtful, progressive recovery plan.

3. Whether managed surgically or non-surgically, the goal is the same: Restore stability. Rebuild strength. Return with confidence.

Struggling with an injury?

If you’re in the San Pedro or Los Angeles area and looking for some help, we are a practice that reflects these values — individualized care, intentional programming, and long-term performance. We’d love to work with you at Physical Therapy San Pedro.

For those outside the area, we also offer telehealth sessions and online programs focused on ankle and knee pain, designed for athletes who want to keep progressing no matter where they’re located.

Stay Connected & Take the Next Step

📅 Book an in-person or virtual session at Physical Therapy San Pedro

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Stay strong. Stay moving.

❤️ Dr. Silverton & Dr. Brown