Posterior glenohumeral dislocation is rare, accounting for less than 3% of all shoulder dislocations. Main etiologies are direct or indirect trauma, seizure and electrocution. The diagnosis is missed in 50 to 80% of the cases on initial presentation because of the rather subtle clinical signs compared to anterior dislocation and inadequate imaging. An unreduced posterior dislocation can lead to severely impairing complications such as recurrent instability, arthritis or avascular necrosis, requiring open reduction and complex surgery with a lower rate of success. The purpose of this article is to highlight and clarify the challenges when confronted with posterior dislocation in order to avoid misdiagnosis. Furthermore it aims to propose an adequate and comprehensible management from the initial diagnosis to the treatment.