Q: Doctor my brother is 32 years old and has been diagnosed with axillary nerve injury, please guide.

A: The Axillary nerve, also known as the circumflex nerve, constitutes an upper extremity nerve affiliated with the posterior cord (C5-C6), offering motor innervation to the deltoid and teres minor muscles. Injury to the axillary nerve can result from various causes such as compressive force, traction injury following anterior dislocation of the shoulder, or forced abduction movement of the shoulder joint.

Manifestations of an axillary nerve injury encompass localized neuropathy, presenting signs and symptoms like pain in the deltoid and anterior shoulder area, loss of movement and/or sensation in the shoulder region, and reported or observed weakness in the deltoid and teres minor muscles during abduction and external rotation. Nerve regeneration occurs at an estimated rate of approximately 1 millimeter per day, leading to a potentially long and discouraging recovery for the patient.

The initial 0-2 weeks of physiotherapy involve shoulder immobilization through a sling after reduction, isometric strengthening with dosing of 10 seconds for 6 repetitions twice a day within pain limits, and joint mobility exercises encompassing passive and active range of motion for the shoulder, elbow, wrist, and hand.

Moving into the 2-4 week phase, joint mobility exercises continue, including passive/active-assisted range of motion for the shoulder and active range of motion for the elbow, wrist, and hand. Strengthening of target muscles, postural/periscapular muscular strengthening, and neuromuscular re-education are introduced, focusing on the deltoid, rhomboid major/minor, serratus anterior, and upper/middle/lower trapezius. From 4-6 weeks, the sling is discontinued, and a light resistive strengthening program is initiated, targeting the deltoids, rotator cuff muscles, and postural muscles. Proprioceptive techniques such as PNF diagonals and closed-chained activities like wall push-ups, table exercises, and floor exercises are introduced.

At 6 weeks, the rehabilitation plan continues with a focus on range of motion, glenohumeral and scapulothoracic stabilization/strengthening exercises, proprioception, and joint mobility while maintaining optimal conditions for tissue healing. Initiation of sport/job-specific activities begins, progressing to a full return as the patient's functional status allows. There is no consensus on when returning to sport/work is appropriate, but improvement on EMG and at least 80% return of deltoid muscle strength are recommended. Return to activity for shoulder dislocation is suggested at approximately 12 weeks and 16 weeks for competitive sports.

Conservative physical therapy treatment may extend between 3 to 6 months. It is crucial for the physical therapist to continuously monitor axillary nerve reinnervation progress and contact the patient's physician if no improvement is observed between 3 to 4 months. The progression of interventions with increased weight or resistance should be tailored to each patient's individual pain tolerance and perceived joint stability during controlled movements.

Q: Doctor, how can a physiotherapist help in depression?

A: A crucial aspect of a physical therapist's role is the recognition of signs and symptoms associated with depression, as well as common disorders linked to this mental health condition. By being sensitive to these indicators, therapists can systematically document them in the care plan and promptly inform physicians when necessary, facilitating appropriate medical interventions for patients experiencing depression. This heightened awareness proves particularly valuable given the emotional instability often associated with depression. Therapists adept at identifying these signs can skillfully navigate various situations, redirecting patients towards alternative activities, providing relevant instructions, or engaging them in more positive conversation topics.

The comprehensive management of depression within physiotherapy involves a holistic approach that seamlessly integrates physical activity and exercise with psychological support. Numerous studies have highlighted the positive impact of physical activity on mood and mental well-being, attributed to the increased release of endorphins, natural mood-boosting chemicals in the brain. It becomes imperative to select enjoyable and sustainable activities—such as walking, cycling, swimming, or dancing—for long-term adherence to the treatment plan. Physiotherapists, recognizing the significance of regular exercise, seamlessly incorporate it into their treatment plans, leveraging its proven efficacy in alleviating depression symptoms and enhancing overall mental health.

Furthermore, physiotherapists may introduce relaxation exercises, breathing techniques, and mindfulness-based interventions tailored to meet the specific needs of each individual. This multifaceted approach enhances stress management and contributes to the overall improvement of mental health. Emotional support and encouragement from physiotherapists play a pivotal role in this context, creating a positive and supportive treatment environment. This, in turn, empowers patients to feel more comfortable and motivated to adhere to their treatment plans, fostering both physical and mental well-being. By actively promoting a healthy lifestyle encompassing exercise, emotional support, and a positive treatment environment, physical therapists play a crucial and holistic role in addressing the multifaceted dimensions of their patients' overall health.