1 · SNAPSHOT
The rehab is straightforward and the decision around it is not.
Illness script in one line: a traumatic event with the arm in abduction and external rotation — a tackle, a throw, a fall — with a pop or a sense of the shoulder leaving, then apprehension in that position and reluctance to take the arm away from the body.
Caseload frequency: common on any placement with a sporting caseload. Read further: incidence in collegiate athletics [1], risk factors [2].
Age at the first dislocation is the whole conversation
Everything on this page bends around one number you already have: how old they were the first time.
Read further: prognosis in anterior shoulder dislocation [3], epidemiology and natural history [4], management of a first-time anterior dislocation [5], an age- and time-specific management consensus statement [6], a multidisciplinary clinical practice guideline on primary traumatic anterior dislocation [7].
The direction, which is all you need:
| First dislocation | What it means for you |
|---|---|
| Teens to mid-twenties, contact or overhead sport | High recurrence. Rehab AND an early surgical opinion. |
| Middle years, non-contact | Rehab, and a conversation about what recurrence would mean for their life. |
| Over 40 | Different problem. Think rotator cuff tear, not recurrence. See section 6. |
2 · SE — THE SUBJECTIVE PATTERN (the 70%)
MAIN PROBLEM
"It came out." Or: it slipped · it felt like it was going to come out · I can't put my arm back there.
Ask whether it went back on its own or someone put it back, and whether they went to hospital. That answer sorts a subluxation from a dislocation and tells you whether it's been imaged.
BODY CHART
- Anterior and deep, sometimes with a diffuse ache over the deltoid.
- ± posterior ache from guarding.
- Any numbness, tingling or weakness — especially over the lateral deltoid — is a neurological question, not a pain question. See section 4.
BEHAVIOUR
- Aggs: abduction and external rotation. The cocking position, reaching back into a car seat, throwing, a tackle, hanging washing, rolling in bed onto the arm.
- Eases: arm in and supported. Many sleep with a pillow under the elbow.
- The signature is not pain — it's the feeling that it's about to go. They will avoid the position rather than tolerate it.
- Irritability: usually low between episodes, high for days after one.
HISTORY — five questions
- Age at the FIRST one. The single most useful number on the page.
- How many times since — and is it taking less force each time?
- What sport, and what position? Collision and overhead change the conversation. Read further: glenohumeral instability in rugby players [8].
- Has it been imaged, and what did the report say? See section 5 — bone loss is the word to listen for.
- What have they stopped doing? The functional loss, not the pain score, is what you'll track.
SPECIAL / SCREENING QUESTIONS
After any dislocation: numbness over the lateral deltoid, deltoid weakness, hand colour or temperature change, any sensory change in the arm. And in anyone over 40: can they lift the arm now, and could they before?
Assessing this region? Download the Shoulder assessment template →
3 · HYPOTHESIS RANKING
Top three, and the one feature that separates each
| Pattern | The discriminating feature |
|---|---|
| 1. Anterior instability | Traumatic ABD/ER mechanism, apprehension (not pain) in that position, abolished by relocation. |
| 2. Rotator cuff–related shoulder pain | Load-related lateral pain and a painful arc, no apprehension, no event. Apprehension beats pain — that's what separates them. |
| 3. SLAP lesion | Deep, poorly localised, with clicking or catching; may follow the same traction injury or dislocation. The two coexist — its own page. |
Also on the list
| Pattern | The discriminating feature |
|---|---|
| Posterior instability | Symptoms with PUSHING — bench press, blocking, flexion–adduction. Not the cocking position. Its own page. |
| Multidirectional instability | Atraumatic, bilateral, hypermobile, "loose" in several directions. Its own page. |
| Rotator cuff tear after dislocation (over 40) | Can't lift the arm afterwards. Systematically reviewed. Section 6. |
| Axillary nerve injury | Numbness over the lateral deltoid, deltoid weakness after a reduction. |
| Associated fracture | Prospectively studied. Persisting severe pain, bony tenderness, not settling. |
Read further: associated injuries after anterior dislocation [9], pathoanatomy, diagnosis and treatment [10][11].
4 · RED FLAGS — DON'T MISS THIS
Free forever. Safety is never behind a paywall.
Almost everything on this list is about the period straight after a reduction — which is exactly when a student sees them.
| Finding | What it means |
|---|---|
| Numbness over the lateral deltoid, or deltoid weakness | AXILLARY NERVE INJURY. Common after dislocation. Examine it, record it, escalate it. |
| Any other sensory or motor deficit in the arm | Brachial plexus involvement. Escalate. |
| Cold, pale, pulseless or discoloured hand | Vascular. EMERGENCY. |
| A shoulder that still looks square, with the arm held out and any attempt to move it refused | Possibly still dislocated. Do NOT mobilise. ED. |
| Severe pain that is not settling, marked bony tenderness, or a mechanism with high force | Associated fracture. Prospectively studied. Image before you rehab. |
| Over 40, and they cannot actively lift the arm since the dislocation | Rotator cuff tear until proven otherwise. Systematically reviewed. Early orthopaedic opinion. |
| Recurrent dislocations with progressively less force | Structural. Get an opinion — this is not a rehab dose problem. |
The rule for this page
Before you treat any post-dislocation shoulder: deltoid sensation, deltoid power, radial pulse, and — over 40 — can they lift the arm. Four things, one minute, recorded.
Any red flag: stop, escalate, and check it with your educator.
5 · OE — THE OBJECTIVE (the 30%)
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The objective exam, management and pearls, plus the six-minute lesson and the debrief. Free with an account.
Sign in or join free6 · MX — MANAGEMENT ESSENTIALS
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Sign in or join free7 · CLINICAL PEARLS + RETRIEVAL CHECK
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The objective exam, management and pearls, plus the six-minute lesson and the debrief. Free with an account.
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Twelve slides on this pattern: what you'll hear, what to examine, what to do. Free with an account.
Sign in or join freeGuideline anchor
No Australian guideline.
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The treatment anchor is a multidisciplinary clinical practice guideline on the treatment of primary traumatic anterior shoulder dislocation in Acta Orthopaedica (Van Gastel et al. 2026, PMID 42573533), with an age- and time-specific management consensus statement (Alentorn-Geli et al. 2026, PMID 41705371). The first-dislocation question is anchored to a systematic review and meta-analysis of the management of first-time anterior shoulder dislocation (Abdel Khalik et al. 2025, PMID 39968414). The clinical anchor is a JBJS review of clinical anatomy, evaluation, imaging and non-operative management (Marcaccio et al. 2025, PMID 40100014). The physiotherapy anchors are a BMJ editorial on acute rehabilitation after traumatic shoulder dislocation (Olds et al. 2024, PMID 38233069) and the development of a rehabilitation guideline for arthroscopic Bankart repair in JOSPT (van Gastel et al. 2024, PMID 38506709).
The guideline and the consensus statement are about surgical and medical decision-making after a primary dislocation. Neither is a physiotherapy management guideline — the JOSPT paper is the development of one for post-operative Bankart rehabilitation, not a finished protocol.
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Verified diagnostic accuracy, where the evidence stands and what it doesn't settle. Free with an account.
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Every source on this page resolves and title-verifies against PubMed. Newest first.
- 2009Owens et al. (2009). Incidence of glenohumeral instability in collegiate athletics. The American journal of sports medicine, 37(9), 1750-4. https://doi.org/10.1177/0363546509334591
- 2014Owens et al. (2014). Risk factors for anterior glenohumeral instability. The American journal of sports medicine, 42(11), 2591-6. https://doi.org/10.1177/0363546514551149
- 1984Simonet & Cofield (1984). Prognosis in anterior shoulder dislocation. The American journal of sports medicine, 12(1), 19-24. https://doi.org/10.1177/036354658401200103
- 2017Galvin et al. (2017). The Epidemiology and Natural History of Anterior Shoulder Instability. Current reviews in musculoskeletal medicine, 10(4), 411-424. https://doi.org/10.1007/s12178-017-9432-5
- 2025Abdel Khalik et al. (2025). Management of First-Time Anterior Shoulder Dislocation-A Systematic Review and Meta-analysis: Arthroscopy Association of Canada Position Statement. Orthopaedic journal of sports medicine, 13(2), 23259671251316893. https://doi.org/10.1177/23259671251316893
- 2026Alentorn-Geli et al. (2026). Age- and time-specific management of traumatic anterior shoulder instability: The 2024 ESSKA-ESA formal consensus. Part 1: History taking, physical exam and imaging studies. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 34(4), 1545-1555. https://doi.org/10.1002/ksa.70336
- 2026Van Gastel et al. (2026). Clinical practice on treatment of primary traumatic anterior shoulder dislocation: a multidisciplinary guideline. Acta orthopaedica, 97, 531-537. https://doi.org/10.2340/17453674.2026.46434
- 2016Funk (2016). Treatment of glenohumeral instability in rugby players. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 24(2), 430-9. https://doi.org/10.1007/s00167-015-3979-8
- 2016Atef et al. (2016). Prevalence of associated injuries after anterior shoulder dislocation: a prospective study. International orthopaedics, 40(3), 519-24. https://doi.org/10.1007/s00264-015-2862-z
- 2011Dumont et al. (2011). Anterior shoulder instability: a review of pathoanatomy, diagnosis and treatment. Current reviews in musculoskeletal medicine, 4(4), 200-7. https://doi.org/10.1007/s12178-011-9092-9
- 2025Goth et al. (2025). Traumatic Anterior Shoulder Dislocation: Epidemiology, Diagnosis, and Treatment. Deutsches Arzteblatt international, 122(4), 89-95. https://doi.org/10.3238/arztebl.m2024.0254
- 2014Longo et al. (2014). Glenoid and humeral head bone loss in traumatic anterior glenohumeral instability: a systematic review. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 22(2), 392-414. https://doi.org/10.1007/s00167-013-2403-5
- 2025Marcaccio et al. (2025). Anterior Glenohumeral Instability: Clinical Anatomy, Clinical Evaluation, Imaging, Nonoperative and Operative Management, and Postoperative Rehabilitation. The Journal of bone and joint surgery. American volume, 107(1), 81-92. https://doi.org/10.2106/JBJS.24.00340
- 2024Olds & Sole (2024). Acute rehabilitation after traumatic shoulder dislocation. BMJ (Clinical research ed.), 384, q21. https://doi.org/10.1136/bmj.q21
- 2026Quintens et al. (2026). Management of a first time anterior shoulder dislocation: the decision-making process of a surgeon. Journal of shoulder and elbow surgery, 35(3), 786-797. https://doi.org/10.1016/j.jse.2025.07.018
- 2026Boutros et al. (2026). Arthroscopic vs Open Bankart Repair for Anterior Shoulder Instability: A Systematic Review and Meta-analysis. The American journal of sports medicine, 3635465261443999. https://doi.org/10.1177/03635465261443999
- 2014Gombera & Sekiya (2014). Rotator cuff tear and glenohumeral instability : a systematic review. Clinical orthopaedics and related research, 472(8), 2448-56. https://doi.org/10.1007/s11999-013-3290-2
- 2024Villarreal-Espinosa et al. (2024). Rehabilitation Protocol Variability Following Arthroscopic Bankart Repair and Remplissage for Management of Anterior Shoulder Instability: A Systematic Review. International journal of sports physical therapy, 19(10), 1172-1187. https://doi.org/10.26603/001c.123481
- 2024van Gastel et al. (2024). Developing a Rehabilitation Guideline (REGUIDE) for Patients Undergoing an Arthroscopic Bankart Repair After Traumatic Anterior Shoulder Dislocation, Focusing on Managing Apprehension: An International Delphi-Based Consensus Study. The Journal of orthopaedic and sports physical therapy, 54(5), 289-301. https://doi.org/10.2519/jospt.2024.12106
- 2026Parrish & Brown (2026). Rehabilitation Utilizing Blood Flow Restriction Following Surgical Repair of a Bankart Lesion with a Buford Complex in an Elite High School Football Player: A Case Report. International journal of sports physical therapy, 21(6), 581-591. https://doi.org/10.26603/001c.162100
Mapped to this pattern
Generic measures that also apply
- Borg RPE
Borg Rating of Perceived Exertion Scale (6-20)
perceived exertion · 1 items · 1 min
- GROC
Global Rating of Change Scale
perceived change since baseline · 1 items · 1 min
- NPRS
Numeric Pain Rating Scale
pain intensity · 1 items · 1 min
- PGIC
Patient Global Impression of Change
perceived change since baseline · 1 items · 1 min
- PSFS
Patient-Specific Functional Scale
patient-generated function · 3 items · 2 min
- SANE
Single Assessment Numeric Evaluation
patient-rated function as a percentage of normal · 1 items · 1 min
- VAS
Visual Analogue Scale
pain intensity · 1 items · 1 min
- Borg CR10
Borg Category Ratio 10 Scale
perceived exertion or symptom intensity, ratio scale · 1 items · 1 min
- GAS
Goal Attainment Scaling
individualised goal achievement · 10 min
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