Shoulder

Shoulder Dislocation

Name: Shoulder Dislocation
Creator: Dr. Kwang Lee

어깨 탈구

Humeral head displaced from glenoid fossa — anterior dislocation in 95% of cases

Written and edited by Dr. Kwang Lee, D.C., L.Ac. · Updated 2026-10-04

How common: Most Common Joint Dislocation (45% of all dislocations)
Typical age: 15–30s (anterior), 50–70s (posterior)

What is it?

Forced abduction+ER drives humeral head anteriorly through the anterior capsule. Bankart lesion (anterior labral tear) and Hill-Sachs lesion (humeral head impaction) predispose to recurrence.

Commonly affected: Anterior capsule/labrum (Bankart), posterosuperior humeral head (Hill-Sachs)

How it develops

Abduction + External Rotation ForceArm forced into abduction + ER — anterior capsule/labrum fails
Anterior DislocationHumeral head displaces anteroinferiorly (subcoracoid most common)
Bankart LesionAnteroinferior labral tear (Bankart) in 90% of dislocations — main cause of recurrence
Hill-Sachs LesionPosterosuperior humeral head impaction fracture on glenoid rim during dislocation

Symptoms

Acute Severe Pain + Spring ResistanceSevere pain; any movement blocked by spring-like resistance (empty glenoid)
Lost Shoulder ContourNormal deltoid contour lost — 'squared off' shoulder; anterior fullness from displaced head
Arm Held in Slight AbductionArm held in 20–30° abduction — any movement extremely painful
Axillary Nerve Injury RiskCheck sensation over deltoid (regimental badge area) — axillary nerve injured in 10–25%

How it is examined

Empty Glenoid Fossa + Contour LossPalpate empty glenoid fossa; humeral head palpable anteriorly under coracoid
Neurovascular Exam (Mandatory)Check axillary nerve sensation (delta patch), radial/ulnar pulse, radial nerve
Apprehension Test (Post-reduction)Abduction + ER: patient's apprehension/guarding confirms anterior instability

Imaging

Pre and post-reduction X-rays mandatory. AP + axillary (Y) view confirms dislocation direction and reduces without missing fracture.

Anterior displacement of humeral head
Hill-Sachs lesion (posterosuperior head impaction)
Bony Bankart (anterior glenoid rim fracture)

MRI arthrogram post-reduction evaluates Bankart lesion (labral tear), Hill-Sachs size, capsular laxity, and concurrent RC tear (especially in >40y).

Bankart lesion (anteroinferior labral tear)
Hill-Sachs lesion size/engagement
Capsular tear/laxity
Concurrent RC tear (>40 years)

Non-surgical care

Closed Reduction (Immediate)Administer IV analgesia/sedation; reduce with Cunningham, Stimson, or Milch technique
Post-reduction Sling + RehabPost-reduction X-ray confirms; sling 3–4 weeks; early ROM then RC strengthening

Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.

When surgery is considered

Young athletes (<25y) with Bankart lesion (80% recurrence); recurrent instability; engaging Hill-Sachs or bony Bankart

Procedures that may be discussed

Arthroscopic Bankart repair (soft tissue)
Latarjet procedure (coracoid transfer — for bone loss or engaging Hill-Sachs)

Outlook

Young athletes: 80% recurrence with conservative care. Arthroscopic Bankart repair reduces recurrence to <10%.