I am a 43-year-old man who dislocated my shoulder while water-skiing. An emergency room doctor put my shoulder back in place. I used a sling and did an exercise program suggested by a therapist. I still cannot raise my arm above my head. Will this improve?

You are right to be concerned that your shoulder motion has not returned, especially after a year. Recent studies have concluded that dislocations in people older than 40 can be associated with other injuries. Among that group, 65 percent had a rotator cuff tendon tear and 11 percent were found to have a nerve injury. These findings are not common in younger patients who dislocate their shoulder. Both of these injuries can be subtle when occurring in combination with a dislocation. The initial inability to raise your arm overhead in the acute stage can be attributed to trauma. However, if you are unable to raise your arm above your head after several weeks, associated injury is a probability. Another cause for poor shoulder motion after a dislocation is joint scarring, called arthrofibrosis. Arthro means joint and fibrosis means scar. This is usually caused from inadequate attempt at motion after dislocation. I prefer a formal course of physical therapy with a registered therapist, who can monitor the progress and refer the person back to the doctor if progress is not made. This allows for earlier evaluation and treatment of these associated injuries. Given your age and medical history, a rotator cuff tendon tear or nerve injury should be ruled out before a reasonable prognosis can be made and appropriate treatment offered.