Will my shoulder dislocate again after the first time?

What happens when a shoulder dislocates?

The shoulder is a ball-and-socket joint with a shallow socket, which allows a wide range of movement but makes it less stable. In an anterior dislocation, the most common type, the ball of the upper arm is forced out of the front of the socket, usually when the arm is raised and turned outwards, as in a tackle or a fall on an outstretched arm.

The dislocation often tears the labrum, a rim of cartilage that deepens the socket, and may damage the bone of the socket or the ball. These injuries make the shoulder more likely to dislocate again.

How likely is another dislocation?

A systematic review and meta-analysis of 10 studies with 1,324 participants found that 39 per cent had recurrent instability after a first-time traumatic anterior shoulder dislocation 1. The risk was higher in people aged 40 or under (odds ratio 13.46), in men (odds ratio 3.18) and in people with generalised joint laxity (odds ratio 2.68) 1.

People who also had a fracture of the greater tuberosity, a bony prominence on the upper arm, had a lower risk of recurrence. The risk of recurrence also decreased as time since the first dislocation increased 1.

Does physiotherapy prevent recurrence?

A systematic review with network meta-analysis of 22 randomised trials found moderate-quality evidence that, with non-surgical management, 47 per cent of patients did not experience another dislocation 2. Rehabilitation focuses on restoring movement, strengthening the rotator cuff and shoulder blade muscles, and improving control of the shoulder in positions of risk.

The same review found very low to low-quality evidence of no benefit from immobilising the arm in external rotation compared with the usual sling position 2.

When is surgery recommended?

The review found moderate-quality evidence that labrum repair reduced the risk of future dislocation, with a relative risk of 0.15 compared with non-surgical treatment 2. Surgery is often discussed early with young athletes in contact or overhead sports, who have the highest recurrence risk.

For others, a period of rehabilitation is often tried first, with surgery considered if the shoulder continues to feel unstable or dislocates again. Bone loss from the socket may require a different type of surgery.

What does rehabilitation involve after a first dislocation?

After the shoulder is put back in place, a sling may be used for comfort for a short period. Gentle movement starts early, followed by progressive strengthening and exercises that challenge stability in different arm positions.

Return to sport depends on full, pain-free movement, good strength and confidence in positions of risk. Contact and overhead athletes need sport-specific training before returning.

Which exercises help stabilise the shoulder?

Rehabilitation usually starts with gentle range of movement and isometric exercises, where muscles are tightened without moving the joint. It progresses to strengthening of the rotator cuff with resistance bands, exercises for the muscles that control the shoulder blade, and closed-chain exercises such as wall push-ups that improve joint stability.

Later stages include training in positions of risk, such as with the arm raised and turned outwards, balance and reaction drills, and sport-specific movements such as throwing or tackling technique. Progress is guided by control and confidence rather than time alone.

What should I do if my shoulder dislocates?

Seek medical care promptly so the shoulder can be assessed and relocated safely, usually with X-rays before and after. Do not let untrained people try to force it back, as this can cause fractures or nerve injury.

Numbness in the arm, particularly over the outer shoulder, weakness or a cold, pale hand needs urgent assessment because nerves or blood vessels may be affected.

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