A dislocated shoulder—when the upper arm bone pops out of its socket—is a sudden shock. But understanding how it's managed and what recovery looks like can help you navigate the process calmly. I’ve structured this guide around key questions patients ask after experiencing a dislocation.
First-time vs Recurrent Dislocations
First-Time Dislocations
- Most are anterior (forward) dislocations—over 95% of cases.
- Young, active people face a high risk of recurrence (<30 years: up to 80–90%).
- Standard care: closed reduction in emergency, followed by sling immobilisation for 1–3 weeks.
- Immobilisation helps with pain but doesn't reduce recurrence risk if prolonged beyond three weeks.
Recurrent Dislocations
- Repeat dislocations gradually damage ligaments, cartilage (Bankart lesion), bone (Hill‑Sachs lesion), and can lead to arthritis.
- Patients often present for specialist review only after several episodes—sometimes up to 18 episodes!
- Recurrent episodes generally necessitate imaging (MRI/X‑ray) and surgical planning.
Immobilisation Protocols
- Duration: 1–3 weeks in internal rotation is recommended.
- Evidence does not support external rotation slings or immobilisation beyond 3 weeks for lowering recurrence risk.
- While in sling, you can move your elbow, wrist, hand; begin gentle scapular muscle exercise.
When Is Surgery Necessary?
First-Time Dislocations
- Typically treated without surgery initially—unless you're young (<25–30), active in contact sports—then early stabilisation may reduce recurrence.
Recurrent Instability
Surgery is considered if you:
- Have ≥2 dislocations, especially if you're young/active
- Show MRI/X-ray injuries: Bankart tear, Hill‑Sachs lesion, or glenoid bone loss (>15–20%)
- Fail to respond to rehab
- Want to return safely to high-demand sports
Surgical Techniques
- Bankart repair (arthroscopic): Reattaches torn labrum, common first-line approach.
- Latarjet procedure: Transfers part of coracoid to rebuild bone in cases of socket bone loss.
- Success rate ~94–99%, but has a longer recovery period (~4–6 months) and carries some risk (e.g. nerve injury).
Rehabilitation Timelines
Non-Surgical Rehab (First-Time/Minor Cases)
- Weeks 0–3: Sling immobilisation; keep joints mobile; begin isometrics for scapula stabilisers.
- Weeks 3–6: Begin gentle active/passive range-of-motion (ROM), aim for ~10° ROM improvement per week.
- Weeks 6–12+: Transition to strengthening rotator cuff and periscapular muscles; progress to functional/sport-specific exercise.
Post-Surgical Rehab
- Sling typically worn 4–6 weeks (varies by procedure).
- Week 1–6: Gentle passive ROM; no lifting or stretching
- Week 6–12+: Begin active movement, progressive resistance strengthening
- 3–6 months: Return to full daily activities; sports clearance usually closer to 6 months depending on procedure and rehab progress
Recovery Expectations
Here’s what most patients can expect, depending on the type and severity of their shoulder dislocation:
- First-time dislocation (non-surgical):
- Recovery time: Around 3–4 months.
- Notes: Most people return to daily activities within a few weeks. Full shoulder strength and mobility usually return with consistent physiotherapy.
- Post–Bankart repair (surgical repair of torn labrum):
- Recovery time: Typically 4–6 months.
- Notes: Most patients regain full shoulder stability and range of motion by 6 months, provided they follow rehab closely.
- Post–Latarjet procedure (for recurrent dislocations with bone loss):
- Recovery time: Usually 4–6 months.
Notes: Slightly longer recovery due to bone healing, but offers excellent long-term stability and lower recurrence rates for active individuals.
Common Patient FAQs
1. How long will my sling be on?
– Typically 1–3 weeks for first-time dislocation; post-op, the sling is usually worn for 4–6 weeks depending on healing and surgeon advice.
2. Why can’t I just wear it longer to prevent recurrence?
– Evidence shows longer immobilisation doesn’t reduce recurrence risk; it increases stiffness and delays rehab.
3. Can a shoulder dislocation heal without surgery?
– Yes, many do—especially those over 30. But young, active individuals—or those with specific injuries—face higher recurrence and may benefit from early surgical repair.
4. What exercise should I start with?
– In the sling phase: elbow/wrist mobilisation, scapula isometrics.
– Once out: gentle passive ROM, then active strength progression led by a physiotherapist.
5. When can I return to sports?
– Non-contact activities: 3–4 months post-injury.
– Contact or overhead sports: usually after 6 months and once ROM/strength are equal to the uninjured side, or earlier only after surgical stabilisation.
6. What symptoms suggest I need surgery?
– Two or more dislocations, persistent instability or apprehension, failed rehab, or imaging revealing serious structural lesions (Bankart, Hill‑Sachs, bone loss).
Summary
- First-time dislocations: reduced and immobilised for ~1–3 weeks, followed by rehab.
- Recurrent dislocations: imaging-led evaluation, stronger consideration for surgery.
- Rehab roadmap: sling → passive ROM → active strengthening → sport-specific training.
- Surgery: Bankart repair (labrum), Latarjet (bone graft) in cases with lesions or heavy activity.
- Recovery: typically 4–6 months depending on injury severity and treatment.
If you’ve had a shoulder dislocation, come to see Dr Khoo early for an accurate diagnosis and personalised recovery plan—to avoid recurrent injury and ensure full functional return.
