Etiology — what causes it

Traumatic — typically anterior dislocation from a fall on an abducted, externally rotated arm, often associated with Bankart and Hill-Sachs lesions. Atraumatic multidirectional instability (MDI) — capsular laxity, sometimes with collagen disorder, often presenting in young athletes (swimming, gymnastics).

Epidemiology — who gets it

Anterior dislocation has highest incidence in young male athletes (15–30 years), with recurrence rates over 70% in those under 25 with no surgery (Robinson et al., JBJS). MDI is more common in young female athletes and may be bilateral.

Clinical signs

Positive apprehension and relocation tests for anterior instability, sulcus sign for inferior laxity, Beighton score for generalized hypermobility. Strength testing of the cuff and scapular stabilizers often shows deficits in MDI.

Symptoms

Traumatic — sense of the shoulder slipping out or dislocating, often in overhead positions. Apprehension at end-range abduction with external rotation. MDI — vague pain, sense of looseness or slipping in multiple directions, often after activities involving repeated overhead use.

Best evidence for chiropractic treatment

For traumatic anterior instability, surgical stabilization is often appropriate in young, high-demand athletes due to high recurrence rates (Bottoni et al., AJSM). Conservative care is reasonable for older patients, those with low demand, and as a first trial. For MDI, the Watson protocol (Watson et al., Shoulder Elbow) provides a structured 12-stage rehab program with good outcomes when followed.

Subtypes

  • Traumatic unidirectional (typically anterior). TUBS — Traumatic Unidirectional Bankart Surgical. Surgery often appropriate in young athletes.
  • Atraumatic multidirectional. AMBRI — Atraumatic Multidirectional Bilateral Rehab Inferior capsular shift. Conservative care first.

When to seek emergency care

Some symptoms need urgent medical attention — not a chiropractic visit. Call 911 or go to the nearest emergency department for: progressive limb weakness, loss of bowel or bladder control, saddle anesthesia (numbness in the groin/inner thighs), severe unrelenting pain unrelieved by position, signs of fracture after significant trauma, chest pain, stroke-like symptoms (face drooping, arm weakness, speech changes), or any rapidly worsening or unusual symptom.

Bottom line

Traumatic dislocators in young athletes often need surgery. MDI almost always responds to structured rehab — Watson protocol is the gold standard.