Posterior shoulder dislocation occurs rarely and is challenging to manage. The mechanisms of trauma are varied, which complicates diagnosis. Missed or delayed diagnosis and treatment can have serious deleterious effects on shoulder function. All cases of suspected posterior shoulder dislocation require a high level of suspicion and appropriate imaging. Identification of associated injuries, such as fractures and rotator cuff tears, is important to guide treatment. In the acute setting, most patients are treated with closed or open reduction with additional soft-tissue or bony procedures. Patients treated in a delayed fashion for persistent instability may require additional procedures, including arthroplasty.