Shoulder Dislocation

A dislocated shoulder means the ball has come out of the socket itself ².

A separated shoulder is a different injury in a different joint. It affects the AC joint at the very top of the shoulder, where the collarbone meets the shoulder blade. It usually comes from landing on the point of the shoulder, and the ball stays in its socket.

A broken bone can happen in the same fall. That's why X-rays are taken to check the ball is back in position and to look for any fracture ².

A dislocation is diagnosed by examination and an X-ray. The clinician checks the shoulder for tenderness, swelling and a change in shape, feels the pulse at your wrist, and tests the feeling and movement in your arm, because a dislocation can injure an artery or a nerve ⁸. An X-ray confirms the shoulder is out ¹. More X-rays follow once it's back in, to check the position and look for a fracture ².

Other scans tend to come later. A CT may be ordered if the bone is hard to see on X-ray. An MRI looks at the ligaments, though it's rarely needed on the day ⁸. You may also be offered a scan to check whether the shoulder has been damaged ¹.

Rehab starts once the shoulder has been put back and checked ^1,2. From there, rehab runs in phases ⁹:

To be straight about the research: rehab after a dislocation is standard, recommended care ^1,2. But the trial evidence is thin. A 2019 Cochrane review found no randomised trials of rehab after a dislocation ⁴. The largest trial since then measured shoulder function, and wasn't designed to show whether rehab prevents re-dislocation ⁶. So we won't promise a result.

Rehab after a dislocation follows The Well Motion Recovery Path™. You move up a phase when the shoulder can cope, not when a week number passes.

• Reset: the sling period, after the shoulder has been put back ^1,2. Ice, the sling, and elbow, wrist and hand exercises ². Expect a stiff, weak arm when the sling comes off. We move you on once your treating doctor or physiotherapist clears you out of the sling ².
• Rebuild: movement comes first, with manual therapy alongside your exercises, then heavier strengthening ⁹. Expect the shoulder to feel uneasy with the arm out to the side and turned back, the position it usually comes out in ⁵. We move you on when the arm does what your daily tasks ask of it without pain or a feeling of slipping.
• Return: work, overhead lifting, or sport through sports physiotherapy. We test strength and control in the positions your work or sport demands. You leave with a strength program to keep up.

How long it usually takes. Recovery usually takes 6 to 12 weeks, and some sports can take 16 weeks or longer ¹. After stabilisation surgery your surgeon sets the timeline. A review of 41 studies of one keyhole repair, mostly case series, found 3 to 6 weeks of immobilisation and averages of 5.2 to 6.4 months before return to sport ¹².

Some of this has been tested in trials and some hasn't, so here's what each piece rests on:

• Age and sex. In a review of ten studies, people aged 40 and under had far higher odds of the shoulder becoming unstable again, and men had about three times the odds of women ⁷. Neither can be changed, but both are worth knowing.
• Surgery, if you're under 25. Stabilisation surgery is the one step that pooled studies support for lowering re-dislocation in young adults ³. That's a conversation for an orthopaedic surgeon.
• Rehab. Strengthening the shoulder is recommended to lower the risk ¹. A trial of 482 adults after a first dislocation found that adding a programme of physiotherapy sessions did no better than one session of advice and home exercises with a physio, plus the option to come back, for shoulder function at six months ⁶. Its main measure was function, not re-dislocation. Re-dislocations were only counted as a complication: 7 of 240 people in the advice group and 3 of 242 in the programme group, too few to show a difference either way ⁶. A smaller Danish trial of 56 people aged 18 to 39 found that 12 weeks of supervised neuromuscular exercise improved shoulder function more than a home programme ¹¹. The gain fell just short of what the researchers counted as clinically important, fewer than half the supervised group kept up with the sessions, and nobody was followed long enough to count re-dislocations ¹¹.
• The first weeks. Don't start shoulder exercises straight away, and avoid lifting the arm up and away from your body until your doctor clears it. It can come out again ².