The question of the initial treatment for primary shoulder dislocation is still challenging. Especially in young and active patients, there is a trend toward surgical repair as the rate of recurrent shoulder dislocation is high after nonsurgical treatment. Immobilization in external rotation and abduction may have an influence on the redislocation rate, although current literature lacks clear evidence concerning the optimal arm position during immobilization for nonoperative treatment of first-time shoulder dislocation. Surgical repair of primary shoulder dislocation has shown to significantly reduce redislocation rates, improve clinical scores, and achieve superior results compared to delayed surgical repair. Therefore, surgical repair can be recommended after primary shoulder dislocation in the young and active patient. Younger age, male gender, overhead activities, poor capsular-labral tissue quality, capsular hyperlaxity, and the presence of bony defects are predisposing factors for recurrent instability after nonoperative treatment. Therefore, they should be considered in the treatment algorithm.