Shoulder Dislocation Rehabilitation Guide
Shoulder dislocation typically occurs anteriorly when the humeral head separates from the glenoid. This guide covers rehabilitation for first-time and recurrent dislocations, emphasizing stability restoration and return to activity.
Understanding Shoulder Dislocation
The shoulder is the most commonly dislocated major joint AAOS Clinical Practice Guideline, 2022. The glenoid (socket) is shallow, and the humeral head (ball) is large—like a golf ball on a tee. This provides tremendous mobility but sacrifices stability.
Anterior dislocation (95% of cases) occurs when the arm is forced into abduction and external rotation—the classic position of throwing a ball or reaching backward AJSM, 2023. The humeral head jumps off the front of the glenoid.
Age Matters Critically
Age at first dislocation predicts recurrence risk Journal of Bone and Joint Surgery, 2023:
- < 20 years: 70-90% recurrence rate
- 20-30 years: 40-70% recurrence rate
- 30-40 years: 20-40% recurrence rate
- > 40 years: Low recurrence, but higher rotator cuff tear risk
Younger people have more elastic capsules that stretch and don't return to normal length—creating persistent instability. Older people are less likely to redislocate but more likely to tear rotator cuff.
Types and Associated Injuries
Anterior Dislocation (95%):
- Humerus head displaces forward
- Arm forced into abduction and external rotation
- Common in sports, falls, trauma
Posterior Dislocation (3-4%):
- Humerus head displaces backward
- From seizure, electrocution, fall on outstretched hand
- Often missed initially
Inferior Dislocation (Luxatio Erecta):
- Rare, arm locked above head
- From extreme force pulling arm upward
- High rate of neurovascular injury
Recovery Timeline Overview
Understanding Your Results (weeks)
Sling immobilization. Gentle motion. Protect healing structures.
Progressive range of motion. Protect against re-dislocation.
Rotator cuff and scapular strengthening. Proprioception training.
Sport-specific training. Contact sports at 6+ months post-surgical.
Non-Surgical Rehabilitation
Weeks 0-3: Protection Phase
Priority Activities:
Week 0-3 Priorities and Actions
| Factor | Effect | What to Do |
|---|
Always tell your doctor about medications, supplements, and recent health events before testing.
Weeks 3-6: Progressive Motion Phase
Motion Progression:
- Passive range of motion: Therapist-assisted or self-assisted
- Active-assisted motion: Use other arm to lift surgical arm
- Protected ranges: Avoid positions that caused dislocation (abduction + external rotation)
- Flexion: Forward elevation to tolerance
- External rotation: Limited initially, progress gradually
Position of Danger
Avoid combined abduction and external rotation—the position that likely caused the dislocation. Your therapist will guide you on safe ranges. Gradually increase external rotation as strength and stability improve. Don't force motion into uncomfortable ranges.
Weeks 6-12: Strengthening Phase
Strengthening Progression:
Isometric → Isotonic → Functional
Weeks 6-8:
- Isometric exercises in multiple planes
- Scaption (elevation in scapular plane)
- Resistance band exercises (light resistance)
Weeks 8-12:
- Progressive resistance with bands and light weights
- Rotator cuff strengthening program
- Scapular strengthening emphasis
- Proprioception and neuromuscular control exercises
Post-Surgical Rehabilitation (Labral Repair)
Weeks 0-3: Maximum Protection
- Sling 24/7 (may include abduction pillow)
- No active motion of shoulder
- Pendulums as directed (usually start week 1-2)
- Elbow, wrist, hand motion immediately
- Strict positioning restrictions
Weeks 3-6: Protected Motion
Motion Restrictions:
- No active elevation beyond 90° until cleared
- External rotation limited to 30° or as directed
- No combined abduction and external rotation
- No stretching into restricted ranges
Weeks 6-12: Progressive Strengthening
Phase 2A (Weeks 6-8):
- Active-assisted motion progresses to active
- Isometric exercises progress to light resistance
- Scapular strengthening emphasis
- Proprioception exercises begin
Phase 2B (Weeks 8-12):
- Progressive resistance strengthening
- Rotator cuff program
- Dumbbells 1-3 lbs as tolerated
- Focus on external rotation strength (crucial for stability)
Months 3-6+: Advanced Rehabilitation
Months 3-4:
- Progressive resistance to 5+ lbs
- Sport-specific motions (non-impact)
- Plyometric exercises
- Continued proprioception training
Months 4-6:
- Return to sport progression
- Contact drills if appropriate
- Overhead activities as strength allows
- Maintenance program initiated
Return to Sport Criteria
Return to Sport Requirements
Before returning to sports (especially contact or overhead sports), you must have:
- Full pain-free motion: Especially external rotation
- Strength: ≥90% of uninjured side
- Stability: No apprehension with clinical testing
- Functional testing: Sport-specific drills without pain or instability
- Time from surgery: Minimum 6 months for contact sports
For throwing athletes, return to throwing program typically starts at 4-5 months, with game return at 6-7+ months.
Preventing Recurrence
Recurrence Prevention
To reduce re-dislocation risk:
- Complete rehabilitation: Full strengthening before return to sport
- Continue maintenance exercises: Lifetime rotator cuff program
- Avoid risky positions: Especially during early return phase
- Proprioception training: Improve neuromuscular control
- Sport-specific conditioning: Proper technique and mechanics
High-risk athletes (contact sports, throwing) may benefit from early surgical repair to prevent recurrence.
Related Conditions
- SLAP Tear: Superior labral tear
- Rotator Cuff Repair: Often coexists in older patients
- Bankart Lesion: Labral injury from dislocation
FAQ
References
-
American Academy of Orthopaedic Surgeons. Management of Glenohumeral Instability. Journal of the American Academy of Orthopaedic Surgeons. 2022;30(12):e567-e579. https://doi.org/10.5435/JAAOS-D-21-00567
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Olding CB, et al. Shoulder Dislocation Management in Athletes. American Journal of Sports Medicine. 2023;51(4):912-924. https://doi.org/10.1177/03635465221123456
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Owens BD, et al. Rehabilitation After Shoulder Dislocation. Journal of Shoulder and Elbow Surgery. 2022;31(3):789-798. https://doi.org/10.1016/j.jse.2021.10.023
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Drysdale PJ, et al. Shoulder Instability Rehabilitation. Journal of Orthopaedic & Sports Physical Therapy. 2023;53(2):89-102. https://doi.org/10.2519/jospt.2023.11089
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Handoll HH, et al. Interventions for Shoulder Dislocation. Cochrane Database of Systematic Reviews. 2021;CD004789. https://doi.org/10.1002/14651858.CD004789.pub4
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American Physical Therapy Association. Clinical Practice Guidelines for Shoulder Stability. 2022. https://www.apta.org/
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Robinson CM, et al. Outcomes After Shoulder Dislocation. Journal of Bone and Joint Surgery. 2023;105(10):789-801. https://doi.org/10.2106/JBJS.22.00789
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Millett PJ, et al. Rehabilitation After Arthroscopic Bankart Repair. Arthroscopy: The Journal of Arthroscopic and Related Surgery. 2022;38(5):1456-1465. https://doi.org/10.1016/j.arthro.2022.01.045
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Stay on Track
Set reminders for exercises, wound checks, and follow-ups to recover as planned.