Chronic locked dislocations of the shoulder are rare injuries. Individual expertise is limited by low number of patients which are often different in presentation and physical demands. These make diagnostic process and treatment decision difficult. Typically, diagnosis of acute dislocation is initially missed. The reason is usually related to low compliance of the patients, frequently in association with alcohol or drug abuse or dementia among other conditions. Factors influencing decision making process are time form injury, relevant bone injury involvement of the glenoid and humeral head and other patient’s related factors. In some patients nonoperative intervention may be the best option. Injuries with significant bone loss on glenoid side and/or humeral head are difficult to treat. Closed reduction after 3 weeks from injury can be unsuccessful. Reconstructive surgery must address bone loss in respect to adhesions and muscle contracture. Arthroplasty should be considered in patients with significant glenoid bone loss, humeral head destruction, osteopenia and arthritis.