Quick answer: After a first shoulder dislocation, young athletes, especially young men in contact sports, have a high chance of dislocating again: more than half within two years in one large study [1]. Arthroscopic stabilization after a first dislocation lowers that risk substantially [2, 3]. Rehab alone is still reasonable for many patients, particularly older or lower-risk athletes. The right choice depends on age, sport, timing in the season, and whether there is bone loss.
Why Shoulders Dislocate Again
Most shoulder dislocations are anterior: the ball pops out the front of the socket [7]. In young patients, this usually tears the labrum and capsule off the front of the socket (a Bankart lesion), and it often dents the back of the ball or chips the socket rim [4]. These injuries frequently do not heal in a position that restores stability, which is why recurrence is so common in younger athletes.
How Likely Is It to Happen Again?
The numbers depend heavily on age:
- In a prospective study of 252 patients aged 15 to 35 treated with a sling and therapy, 56% had recurrent instability within two years and 67% by five years. Young men had the highest risk, and most recurrences happened within the first two years [1].
- In a 25-year follow-up of patients aged 12 to 40, about half of the dislocations in patients aged 12 to 25 had not recurred or had become stable over time. About 27% of all shoulders eventually needed surgery for recurrent instability. Immobilizing the arm after the first dislocation did not change the long-term outcome [5].
Does Early Surgery Help?
Randomized trials show that early arthroscopic stabilization lowers recurrence:
- In a trial of young, active military patients, 75% of those treated without surgery developed recurrent instability, compared with 11% after arthroscopic repair [2].
- In a double-blind trial of adults under 35, arthroscopic Bankart repair reduced the risk of another dislocation by 76% compared with arthroscopy alone. Patients who had the repair and played contact sports were 3.4 times more likely to be back in their sport at two years [3].
One important nuance from that same trial: patients whose shoulders stayed stable had similar function regardless of treatment. The benefit of surgery comes mainly from preventing further instability, not from making a stable shoulder function better [3].
What About Returning to Play This Season?
In-season athletes often want to finish the season. In a prospective study of college contact athletes treated with accelerated rehabilitation, 73% returned to play, after a median of only five days lost. However, nearly two-thirds of those who returned had another instability episode during the season, and only 27% completed the season without recurrence [6]. Athletes with a partial dislocation (subluxation) were more likely to return than those with a full dislocation [6].
Returning in-season can be reasonable for some athletes, but it should be a shared decision that weighs the risk of further damage to the labrum, cartilage, and bone.
When Is a Bigger Operation Needed?
Not every shoulder is a good candidate for arthroscopic repair. A widely used scoring system identified factors that raise the risk of failure after an arthroscopic Bankart repair: age under 20, competitive or contact sports, loose joints, and visible bone loss on X-ray. Patients with high scores had a 70% recurrence rate after arthroscopic repair, and the authors recommended a bone-block procedure (Latarjet) instead [4]. This is why imaging after a first dislocation, often including a CT scan or MRI, matters.
Who Should Consider Early Surgery?
Early stabilization is worth discussing if you:
- Are a young athlete, especially in a contact or collision sport
- Play an overhead sport or work in a job that relies on overhead strength
- Have bone loss on imaging
- Have already had a second dislocation or ongoing feelings of instability
Rehab first is often reasonable if you are older, play a lower-risk sport, or have a partial dislocation without bone injury.
Frequently Asked Questions
Should my shoulder be put in a sling for weeks after a dislocation?
A short period of sling use for comfort is common, but in long-term follow-up, prolonged immobilization did not change the chance of another dislocation [5].
How long does recovery from arthroscopic stabilization take?
Most patients wear a sling for several weeks, then progress through therapy. Return to contact sports typically takes several months; your surgeon will guide timing based on strength and motion.
Does every dislocation need an MRI?
Not always, but imaging is often helpful in young athletes to look for labral tears and bone loss, which affect the choice of treatment [4].
What if I'm over 40 and dislocated my shoulder?
Older patients have a lower risk of recurrence but a higher risk of rotator cuff tears with dislocation. Weakness after a dislocation in an older adult should be evaluated promptly. See When to See a Shoulder Specialist.
Getting Evaluated
Dr. Tej Joshi treats shoulder instability, from first-time dislocations to revision stabilization, and performs arthroscopic and open stabilization surgery. He sees patients at NYU Langone offices in Manhattan, Lake Success, and Bay Ridge, Brooklyn.
References
- 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. PubMed 17079387 · doi:10.2106/JBJS.E.01327
- Bottoni CR, Wilckens JH, DeBerardino TM, et al. A prospective, randomized evaluation of arthroscopic stabilization versus nonoperative treatment in patients with acute, traumatic, first-time shoulder dislocations. Am J Sports Med. 2002;30(4):576-580. PubMed 12130413 · doi:10.1177/03635465020300041801
- Robinson CM, Jenkins PJ, White TO, Ker A, Will E. Primary arthroscopic stabilization for a first-time anterior dislocation of the shoulder. A randomized, double-blind trial. J Bone Joint Surg Am. 2008;90(4):708-721. PubMed 18381306 · doi:10.2106/JBJS.G.00679
- Balg F, Boileau P. The instability severity index score. A simple pre-operative score to select patients for arthroscopic or open shoulder stabilisation. J Bone Joint Surg Br. 2007;89(11):1470-1477. PubMed 17998184 · doi:10.1302/0301-620X.89B11.18962
- Hovelius L, Olofsson A, Sandström B, et al. Nonoperative treatment of primary anterior shoulder dislocation in patients forty years of age and younger. A prospective twenty-five-year follow-up. J Bone Joint Surg Am. 2008;90(5):945-952. PubMed 18451384 · doi:10.2106/JBJS.G.00070
- Dickens JF, Owens BD, Cameron KL, et al. Return to play and recurrent instability after in-season anterior shoulder instability: a prospective multicenter study. Am J Sports Med. 2014;42(12):2842-2850. PubMed 25378207 · doi:10.1177/0363546514553181
- American Academy of Orthopaedic Surgeons. Dislocated Shoulder. OrthoInfo. orthoinfo.org