Glenohumeral Dislocation: Overview and Evidence Summary

Condition Overview

A glenohumeral dislocation occurs when the humeral head is forced out of the glenoid fossa, disrupting the delicate balance between mobility and stability that defines shoulder function. The shoulder is a marvel of human anatomy, capable of extraordinary motion because it sacrifices depth of the socket for range. This design, however, comes at a cost: the glenohumeral joint is the most commonly dislocated major joint in the body.

Most dislocations are anterior, with the humeral head shifting forward and downward after the arm is forced into abduction, external rotation, or a combination of overhead loading and impact. These injuries often occur in sports such as rugby, football, skiing, basketball, and martial arts, or during everyday falls. Posterior dislocations, although rare, are clinically important because they are frequently missed during initial assessment. They typically occur after seizures, electric shock, or extreme internal rotation force. Inferior dislocations (luxatio erecta) are exceedingly rare and usually associated with high-energy trauma.

The moment of dislocation is often unforgettable: sudden sharp pain, immediate loss of shoulder movement, visible deformity, and overwhelming muscle spasm. Once reduced, pain usually diminishes quickly, but the event leaves behind a trail of structural consequences—stretched or torn ligaments, possible capsular detachment, labral damage, bone bruising, and in some cases, associated rotator cuff injuries.

The risk of recurrence after the first dislocation varies dramatically by age and activity level. Adolescents and adults under 25—especially those involved in contact or overhead sports—have the highest recurrence rates, sometimes exceeding 70% if not properly rehabilitated. Older adults, on the other hand, are less likely to experience recurrent instability but more likely to sustain rotator cuff tears at the moment of injury.

A thoughtful rehabilitation plan following reduction is essential. The goals are to restore mobility without provoking instability, strengthen the dynamic stabilizers of the joint, re-establish proprioception, and correct movement patterns that might predispose someone to future dislocations.

Summary of Current Evidence for Glenohumeral Dislocation

Evidence-Based Management Discussion

Biomechanics and Pathophysiology

Understanding the mechanics of dislocation is central to effective treatment. The stabilizers of the shoulder include:

1. Static stabilizers:

   • Glenoid labrum, which deepens the socket

   • Joint capsule and glenohumeral ligaments

   • Negative intra-articular pressure

2. Dynamic stabilizers:

   • Rotator cuff muscles

   • Scapular musculature (serratus anterior, trapezius)

   • Long head of the biceps tendon

During an anterior dislocation, the humeral head often impacts the anterior-inferior rim of the glenoid, leading to a Bankart lesion (detachment of the labrum and capsule). Simultaneously, the posterior humeral head may be indented, producing a Hill-Sachs lesion. These structural changes influence the risk of future instability.

Posterior dislocations, although rarer, present differently. The arm is often locked in internal rotation, and patients may report severe discomfort when attempting external rotation. Because radiographs can miss posterior dislocations, clinical suspicion is essential.

Initial Management and Immobilization

The first priority is safe reduction, followed by assessment of neurovascular function, including the axillary nerve—a common site of injury. Immobilization duration is debated, but most evidence supports short periods (1–2 weeks) rather than prolonged sling use. Younger patients may benefit from slightly longer protection, but immobilization beyond three weeks offers no added benefit and may increase stiffness.

After immobilization, gentle active-assisted movement begins, avoiding excessive external rotation early on to protect healing tissues.

Exercise Therapy

Rehabilitation is the cornerstone of successful recovery—especially for individuals hoping to avoid recurrent instability.

A structured program includes:

1. Rotator Cuff Strengthening

The rotator cuff helps center the humeral head within the glenoid, resisting translation forces.

Key components:

• External rotation strengthening at varying abduction angles

• Subscapularis activation for anterior stability

• Isometrics progressing to eccentrics and controlled concentric loading

2. Scapular Control

Correct scapular motion maintains glenoid alignment. Dysfunction can significantly increase instability risk.

Focus areas:

• Lower trapezius and serratus anterior activation

• Posterior tilt and upward rotation patterns

• Closed-chain scapular control drills

3. Proprioception and Neuromuscular Retraining

Capsular and labral injury reduces joint position sense. Without retraining, recurrence is more likely.

Training includes:

• Rhythmic stabilization

• Perturbation training

• Closed-chain weight shifts

• Sport-specific neuromuscular drills

4. Kinetic Chain Integration

Particularly for athletes, lower-body and core contribution to overhead or contact movements must be restored.

Return-to-sport timelines vary widely and depend on achieving:

• Pain-free full ROM

• Strength symmetry

• No instability signs

• Successful completion of progressive sport-specific tasks

Manual Therapy

Manual therapy supports recovery by restoring mobility lost after immobilization or guarding. Mobilizations are cautiously introduced once acute pain subsides and stability is confirmed. Posterior capsule tightness is especially relevant in athletes, as it can alter humeral head translation during overhead motion.

Soft tissue work along the rotator cuff, deltoid, and scapular stabilizers can reduce sensitivity and facilitate better movement patterns.

Medications and Injections

Analgesics help patients tolerate early movement. NSAIDs reduce inflammation but must be used judiciously in older adults. Steroid injections play no role acutely but may be considered in chronic pain stemming from secondary issues like synovitis or rotator cuff irritation.

Surgical Considerations

Surgical stabilization may be required if:

• Dislocation recurs

• Labral or capsular injury is significant

• The patient participates in high-risk sports

• A Hill-Sachs lesion is large or “engaging”

• Glenoid bone loss compromises stability

Arthroscopic Bankart repair is common and has high success rates in appropriate candidates. Remplissage, Latarjet, or other procedures may be chosen based on bone loss patterns and instability severity.

Prognosis

Early rehabilitation, appropriate progression of loading, and attention to movement quality can significantly reduce recurrence risk. Nonetheless, young athletic males remain the highest-risk group for repeat dislocation, even with excellent rehabilitation. Older adults tend to avoid recurrence but must be monitored for rotator cuff involvement, which can limit functional recovery.

References

Itoi, E., et al. “Shoulder Instability: Pathophysiology and Management.” Journal of Orthopaedic Science, 2017.

Owens, B., et al. “Risk Factors for Recurrent Shoulder Instability.” American Journal of Sports Medicine, 2011.

Olds, M., et al. “Rehabilitation Following Traumatic Anterior Shoulder Dislocation.” Sports Medicine, 2019.

Arciero, R., et al. “Management of Shoulder Instability in Athletes.” Orthopaedic Journal of Sports Medicine, 2015.

Burkhart, S., et al. “The Hill-Sachs Lesion and Its Role in Shoulder Instability.” Arthroscopy, 2000 and updates.

Disclaimer

The information in this article is intended for educational purposes and is designed for qualified massage therapists, manual therapists, and rehabilitation professionals. It is not a substitute for medical advice, diagnosis, or treatment. Practitioners must work within their legal scope of practice and regional regulations. Hands-on techniques should only be performed by appropriately trained and licensed individuals. Niel Asher Education is not responsible for any injury, loss, or damage resulting from the use of this content.