After a shoulder dislocation, do you need surgery?

Short answer

The younger you are, the more surgery came out ahead. Surgery after a first dislocation cut recurrence from 46.6% to 6.3%. Among people who skipped surgery, 38% of those aged 12 to 25 and 18% of those aged 26 to 40 ended up having it anyway.

After a shoulder dislocation, do you need surgery?
'Once it pops out, it pops out again → surgery right away' — does this formula hold?
After a first dislocation, there are two paths: put the joint back, keep the arm still, and rehab, or have surgery right away to stitch the torn tissue. We compared what studies found for each path.
Without surgery, how often does it happen again?
4 in 10 became unstable again
An analysis that pooled 1,324 people found that 39% dislocated again or became unstable after the first time. The risk was 13.46 times higher at age 40 or under, and 3.18 times higher in men. The longer it had been since the first dislocation, the less often it came back.
Surgery right after the first dislocation
Recurrence fell from 46.6% to 6.3%
An analysis of 5 randomized trials with 259 people, followed for about 5 years on average, found that 6.3% became unstable again after surgery, versus 46.6% with a sling only. The share who ended up needing surgery later was 4.0% versus 30.8%.
Return to sport differed too
Back to the same level after 6 years: 82% vs 21%
In a trial that randomly split 40 people and followed them for over 6 years, 27.8% became unstable again after surgery, versus 89.5% without it. 82% versus 21% returned to sport at their old level or higher. An analysis of 11 studies with 694 people also found surgery 3.87 times ahead on returning to sport.
But half the shoulders without surgery were fine
After 25 years, 27% had surgery
When 229 shoulders treated without surgery were followed for 25 years, 43% never dislocated again and 7% did so only once. Another 14.4% dislocated repeatedly but became stable over time. In the end, 27% had surgery.
Age was the dividing line
38% at ages 12 to 25, 18% at ages 26 to 40 had surgery
In the same 25-year study, 38% of people who were 12 to 25 at their first dislocation ended up having surgery, versus 18% of those who were 26 to 40. The Arthroscopy Association of Canada also named male sex, young age, and contact sports as recurrence risks and recommended surgery after a first dislocation in those cases.
Summary: the younger and more active, the more surgery came out ahead
'Surgery right away' is not a formula for everyone
Surgery right after a first dislocation cut recurrence from 46.6% to 6.3% and more people returned to sport. Most people in these comparison trials were young. The older people were, the less often they ended up needing surgery after skipping it (18%).