1. Introduction / Plain Theory

A shoulder dislocation occurs when the head of the upper arm bone (humerus) is forced out of its socket in the shoulder blade (glenoid fossa).
It is one of the most common large-joint dislocations, accounting for nearly 50% of all major joint dislocations, and typically results from trauma such as a fall, sports injury, or sudden impact.

The shoulder’s remarkable mobility makes it inherently less stable. The joint is supported by the capsule, labrum, and surrounding rotator cuff muscles, all of which can be stretched or torn during dislocation.

The majority of dislocations are anterior (forward), while posterior or inferior dislocations are less common and usually occur after seizures or direct trauma.

Although most dislocations are successfully reduced (put back in place) in hospital, the surrounding soft tissues require time and rehabilitation to regain stability. Recurrent instability is common, particularly in younger and more active individuals.

2. Typical Symptoms and Functional Impact

• Sudden, severe pain in the shoulder following trauma.

• Visible deformity or “flattened” appearance of the shoulder contour.

• Inability to move the arm or a sensation that it is “out of place.”

• Swelling, bruising, or muscle spasm.

• After reduction: ongoing soreness, weakness, or apprehension when moving the arm overhead.

Functional impact:
A dislocation can significantly limit daily activities, sports participation, and work requiring upper limb strength. Recurrent instability may cause fear of movement and reduced confidence in the shoulder.

Red flags:
A suspected dislocation should always be reduced by medical professionals — never by manipulation outside a clinical setting. Associated fractures, nerve injuries, or vascular compromise must be ruled out before any manual treatment is considered.

3. Contributing Factors / Underlying Causes

• Traumatic injury: fall onto an outstretched arm or direct blow.

• Repetitive strain: overhead sports (e.g., volleyball, swimming, tennis) increasing capsule laxity.

• Previous dislocations: stretching or tearing of stabilizing structures such as the labrum or capsule.

• Muscle imbalance: inadequate strength of rotator cuff or scapular stabilizers.

• Hypermobility or connective tissue laxity: predisposes to recurrent instability.

• Postural and thoracic restrictions: may alter scapular mechanics and load distribution.

Each case requires differentiation between first-time dislocation, recurrent instability, and post-surgical rehabilitation to determine safe manual intervention.

4. Osteopathic Approach

Osteopathic care is not indicated during the acute dislocation phase, which is a medical emergency.
Once the shoulder has been reduced and cleared of serious injury, osteopathic treatment may help support recovery by:

• Addressing residual muscle spasm and protective tension around the shoulder and upper thorax.

• Improving mobility of the scapula, clavicle, and thoracic spine to optimise shoulder rhythm.

• Supporting circulation, lymphatic drainage, and tissue healing through gentle soft-tissue and myofascial techniques.

• Guiding gradual reintroduction of pain-free motion, in collaboration with physiotherapy and rehabilitation programs.

• Working to prevent compensatory strain patterns in the neck and upper back.

Osteopathic care aims to restore balanced motion and stability throughout the shoulder complex and related structures — complementing medical and rehabilitative management.

5. Scientific Evidence & References

Evidence supports a multidisciplinary rehabilitation approach following shoulder dislocation, combining manual therapy, exercise, and proprioceptive retraining.
Manual therapy can improve pain and motion in post-reduction and post-surgical phases, provided that all precautions and tissue healing timelines are respected.
Osteopathic and soft-tissue techniques are safe and effective adjuncts when used conservatively under medical clearance.

References

1. Zacchilli MA, Owens BD. Epidemiology of shoulder dislocations presenting to emergency departments in the United States. J Bone Joint Surg Am. 2010;92(3):542–549. Link

2. Cutts S, Prempeh M, Drew S. Anterior shoulder dislocation. Ann R Coll Surg Engl. 2009;91(1):2–7. Link

3. Robinson CM, Howes J, Murdoch H, Will E, Graham C. Functional outcome and risk of recurrent instability after primary traumatic anterior shoulder dislocation in young patients. J Bone Joint Surg Am. 2006;88(11):2326–2336. Link

4. Hanchard NC, Goodchild L, Kottam L, et al. Physiotherapy rehabilitation after shoulder dislocation: systematic review. BMJ Open Sport Exerc Med. 2018;4(1):e000415. Link

5. Cools AM, Borms D, Cagnie B, et al. Rehabilitation of the athlete’s shoulder: a comprehensive review of exercise and manual therapy strategies. Br J Sports Med. 2015;49(5):327–334. Link

6. Ginn KA, Cohen ML. Exercise therapy for shoulder pain aimed at restoring neuromuscular control: a review of clinical trials. J Electromyogr Kinesiol. 2005;15(2):150–160. Link

7. Franke H, Fryer G, Ostelo RWJG, et al. Osteopathic manipulative treatment for musculoskeletal pain: systematic review and meta-analysis of randomized controlled trials. BMC Musculoskelet Disord. 2014;15:286. Link

8. van der Meijden OA, Gaskill TR, Millett PJ. Rehabilitation after shoulder instability surgery: a biomechanical perspective. J Athl Train. 2012;47(3):334–348. Link