Fracture

Shoulder Dislocation (Anterior)

Most common joint dislocation (50%). Anterior type in 95% of cases. Bankart lesion and Hill-Sachs defect.

The anterior shoulder dislocation is the most common joint dislocation, representing 50% of all dislocations. It occurs when the humeral head exits the glenoid anteriorly and inferiorly, typically during a movement of abduction + external rotation + arm extension (fall, sport). It is associated with Bankart lesion (anterior labral tear, 90% of cases) and Hill-Sachs defect (posterior humeral head compression fracture, 65-70%). The recurrence rate is very high in young patients (80-90% before age 20) and decreases with age. The bony Bankart lesion (glenoid bone loss) is a key factor in surgical decision-making.

Characteristics

  • Typical shoulder deformity: shoulder squaring (loss of deltoid contour), arm in abduction and external rotation, void under the acromion palpable. Severe pain and total functional impairment.
  • Mandatory pre-reduction X-rays (AP + axillary or Velpeau) to rule out associated fracture. Post-reduction X-ray to confirm congruent reduction.
  • Always check axillary nerve function (deltoid sensitivity on lateral aspect of shoulder) and rotator cuff integrity (especially > 40 years: associated supraspinatus tear in 30-40%).
  • CT scan with 3D reconstruction: quantification of glenoid bone loss (> 15% = Latarjet indication) and Hill-Sachs defect (on-track vs off-track concept).

Medical and surgical management

  • First dislocation > 30 years, no bone loss: conservative treatment. Immobilization 3-4 weeks then rehabilitation. Recurrence 25-50%.
  • Recurrent dislocation without significant bone loss (< 15%): arthroscopic Bankart repair (reattachment of the labrum with anchors). Success rate 85-90%.
  • Significant glenoid bone loss (> 15%) or contact athletes: Latarjet procedure (coracoid transfer to the anterior glenoid rim). Recurrence rate < 5%.

Physiotherapy rehabilitation

  • Post-reduction: immobilization in internal rotation or external rotation (debated) for 3-4 weeks. Cryotherapy, elbow and hand mobilization.
  • Strengthening of dynamic stabilizers: rotator cuff (external rotators +++), subscapularis, scapular stabilizers. Closed kinetic chain exercises initially.
  • Proprioception and neuromuscular control: progressive work in at-risk positions (abduction + external rotation). Confidence recovery.
  • Post-surgical rehabilitation (Bankart/Latarjet): immobilization 4-6 weeks, then progressive mobilization. No external rotation > 0° for 6 weeks after Bankart.

Classification

  1. First dislocation

    First episode. Conservative treatment. High recurrence risk in young patients.

  2. Recurrent instability

    Multiple dislocation episodes. Bankart or Latarjet procedure indication.

  3. Dislocation with bone loss

    Significant glenoid or humeral head bone loss. Latarjet or bone graft.

  4. Recurrent dislocation

    Risk of recurrence after a dislocation.

Average duration

12 to 24 weeks of rehabilitation

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Scientific sources

General information only: this content cannot provide a diagnosis or prescription. A healthcare professional must assess your situation.