Q: My father-in-law, while travelling in a long distance bus, got an anterior dislocation of the shoulder due to the sudden application of brakes. For treatment his shoulder was manipulated under general anaesthesia and then a sling was put. It has been so for 4 to 6 weeks. What are the exercises which he has to do after this? Also, are there any precautions he needs to take?

A:The basic objective of physiotherapy management is to regain shoulder movements and strengthening of shoulder muscles. 1. A pendular swinging movement in a forward stop position is initiated. The normal hand should be rested on the plinth to ensure stabilization of the trunk while doing this. 2. Relaxed passive abduction up to 45 degrees should be done by the physiotherapist. 3. With the arm close to the side of the body, the therapist will guide him for external rotation movements. 4. In supine lying, (on his back) self assisted movements can be started. 5. Once a good passive range is attained regime of strengthening is begun. The therapist will teach him isometric and isotonic contractions and exercises with small weights can be done in the department under supervision. 6. By 6-8 weeks, 80%-90% movement can be achieved. 7. By 12 weeks he can expect full recovery. You should be careful that he does not develop any of the following complications during this period: -Stiffness of the shoulder joint. -Recurrent dislocation of the shoulder. -Supraspinatus tendinitis. -Rotator cuff injury. I am sure you have seen the kind of expertise required to carry out the exercises. Hence, I would not suggest that he carry out anything without supervision and following certain diagrams. You need to be very careful in these cases. He will do well, so take him to a therapist and start gradually.