Shoulder dislocation: understanding this episode and making your return to sport safe

What is a shoulder dislocation?

Shoulder dislocation anatomy

A shoulder dislocation is a complete loss of contact between the head of the humerus and the shoulder blade’s socket (the glenoid), most often forward (anterior dislocation, the most common type). It’s the most common joint dislocation in the human body, directly linked to this joint’s great mobility, which comes at the expense of its stability.[1]

Why does this dislocation happen?

Dislocation most often occurs during direct trauma (a fall, an impact) or a forced cocked-arm movement (external rotation, arm raised), the position in which the shoulder is most vulnerable. It can damage the labrum (a Bankart lesion) or the bone of the humeral head (a Hill-Sachs lesion), which increases the risk of future recurrence.

Dislocation or subluxation: what’s the difference?

A dislocation is a complete loss of contact between the head of the humerus and the glenoid, which requires reduction (putting it back in place) by a healthcare professional. A subluxation is a partial displacement, often followed by spontaneous reduction. Both share the same risk factors and the same rehab approach.

Structures that can be damaged

During a dislocation, several structures can be damaged, which affects the risk of recurrence:

• The labrum, the cartilage rim that lines the glenoid (a Bankart lesion if it tears)
• The humeral head, which can develop a small bony notch (a Hill-Sachs lesion)
• The joint capsule and gleno-humeral ligaments, which stretch

Symptoms and diagnosis of a shoulder dislocation

Typical signs at the time of the episode

A dislocation causes intense, immediate pain, a visible deformity in the shoulder’s contour, and an inability to move the arm normally. Temporary numbness or tingling in the arm can appear, linked to stretching of nearby nerve structures, and usually disappears after reduction.

How it progresses without complete rehab

The main risk after a dislocation is recurrence, particularly high in young athletes after a first episode.[2] Psychological apprehension can also settle in durably around at-risk movements (arm raised, external rotation), limiting confidence and sporting performance well after the tissues have healed.

Differential diagnosis

After a shoulder injury, several diagnoses need to be distinguished:

• Subluxation, a partial displacement with spontaneous reduction
• An associated fracture of the humeral head or glenoid rim, which should always be checked for with imaging
• A brachial plexus injury, rare but more serious, if numbness in the arm persists beyond a few hours

Causes and risk factors

A dislocation almost always follows an identifiable trauma, but certain factors clearly increase the risk, particularly of recurrence.

Biomechanical and personal factors

• A young age at the time of the first episode, the main risk factor for recurrence[2]
• Constitutional joint hyperlaxity
• A Bankart or Hill-Sachs lesion after a first episode, which structurally weakens the shoulder
• A lack of rotator cuff strengthening

Which sports contribute to shoulder dislocation?

All sports that place the arm in a cocked position or expose you to a risk of falling directly on the shoulder are involved:

• Rugby, during tackles and falls
• Handball and volleyball
• Judo and combat sports
• Skiing and snowboarding
• Climbing
• Throwing sports

Why is the risk of recurrence so high after a first dislocation?

Each dislocation episode can damage the labrum or bone a little more, making the shoulder mechanically less stable for next time. Without complete active strengthening of the rotator cuff and shoulder blade stabilisers, this structural instability isn’t compensated for, which explains why the risk of recurrence stays high even once the initial pain is forgotten.

Treating a shoulder dislocation in rehab with a sports physio

Once the dislocation has been reduced by a healthcare professional, the goal of treatment is to progressively strengthen the structures that actively stabilise the shoulder to prevent recurrence, which is very common without suitable rehab.

Phase 1 – Protection after reduction

After it’s put back in place by a healthcare professional, a period of immobilisation or relative rest is prescribed to let the tissues stabilise, before starting active rehab.

Phase 2 – Strengthening active stability

Strengthening the rotator cuff and shoulder blade stabilisers, combined with proprioceptive work, then becomes the priority to compensate for the mechanical fragility left by the dislocation.

Phase 3 – Return to sport

The final phase progressively reintroduces at-risk movements (cocked arm, contact) before a full return to training and then competition, with particular attention paid to rebuilding confidence in these movements.

In practice, this programme breaks down into 10 concrete steps:

1. 1Protection and reducing pain
2. 2Recovering pain-free mobility
3. 3Isometric strengthening of the cuff
4. 4Strengthening shoulder blade stability
5. 5Shoulder proprioceptive work
6. 6Closed-chain strengthening
7. 7Open-chain strengthening
8. 8Strengthening under sport-specific load
9. 9Progressive return to your sport
10. 10Return to competition

“The first dislocation is treated, further ones are prevented, through real strengthening work.”

Strengthening active stability, the cornerstone of treatment

Strengthening the rotator cuff and the shoulder blade stabilisers creates the dynamic stability that’s essential after a dislocation, particularly in young athletes who have the highest risk of recurrence. Proprioceptive work also trains the shoulder’s protective reflexes.

In brief

• Complete rotator cuff strengthening
• Shoulder proprioceptive work
• Strengthening the shoulder blade stabilisers
• Gradual return: mobility, then load, then sport

Should you rest or keep playing sport?

After the initial immobilisation period prescribed by the doctor, prolonged rest isn’t recommended: it’s active, progressive strengthening that durably protects the shoulder against further dislocation.

When should you see a specialist for a shoulder dislocation?

Any dislocation must be urgently reduced by a healthcare professional if this hasn’t already been done. A medical opinion is then needed to assess the condition of the structures (labrum, bone) and discuss whether surgical stabilisation might be necessary, particularly in young athletes at high risk of recurrence.

Recovery time: how long does it take to recover from a shoulder dislocation?

After the initial immobilisation period (generally 1 to 3 weeks, depending on the medical prescription), active strengthening extends over 6 to 12 weeks. A full return to at-risk sports (contact, cocked arm) is safer between 3 and 6 months, the time it takes for active stability to be fully restored.

Factors that speed up or slow down healing

Preventing re-injury

Shoulder dislocation is one of the injuries most likely to recur if strengthening isn’t continued once mobility has been regained.

The 10% progression rule

Not increasing training volume or intensity by more than 10% per week, particularly for cocked-arm movements, protects the shoulder during its phase of relative fragility.

Ongoing rotator cuff maintenance

Regular resisted external rotation work (band or light load), kept up even after initial rehab ends, maintains the shoulder’s active stability. It’s this ongoing strengthening, more than rest, that concretely reduces the long-term risk of recurrence.

The HOPP care programmes to treat your shoulder dislocation and safely get back to sport

This dislocation requires complete strengthening and proprioceptive work to durably secure your shoulder and prevent recurrence. HOPP offers you a precise exercise programme, allowing you to get back to your activities as quickly as possible.

The programme runs from 3 to 9 weeks depending on the injury and ends with a reconditioning phase allowing a return to competition in the best possible conditions. Each programme is designed by the HOPP team, made up of two sports physiotherapists who are experts in assessing and treating athletes. You’ll also find theoretical content throughout your progression, so you master every aspect of your recovery and can adjust your treatment independently. If needed, our team of physiotherapists is on hand to support you.

A programme that adapts to you every day

Every day, how you feel (RPE) is factored in to automatically adjust the rest of your programme: more load if all is well, a bit less if your shoulder is complaining. This daily personalisation is what makes the difference compared to a fixed, paper-based programme.

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