Q: I'm a 31-year-old male who experienced a dislocated shoulder following an accident. Could you please provide guidance on how a physiotherapist can assist in my recovery?
A: Traumatic shoulder dislocation stands out as the most prevalent large joint dislocation in the human body, frequently occurring in sports and primarily affecting a younger demographic. Early intervention becomes crucial to mitigate the risk of chronic shoulder instability in the future for these patients. There are two distinct types of traumatic dislocation, with anterior dislocation being the most prevalent, accounting for up to 97% of cases. In contrast, posterior dislocations, constituting only 3%, present unique complexities often involving associated injuries to the rotator cuff muscles.

Non-traumatic shoulder dislocations can also manifest, particularly in athletes like throwers and swimmers, where repetitive shoulder movements gradually stretch the soft tissue cover around the joint (the joint capsule). Capsular stretching can result in weakened rotator cuff muscles, causing an imbalance in shoulder muscle interaction. Given the prevalence of traumatic anterior dislocation, the ensuing information will predominantly address this type.

A traumatic anterior shoulder dislocation inflicts significant pain across the upper arm, axilla region, and shoulder joint. Typically, the arm is held in medial rotation (across the body), with any movement away from the body intensifying pain. Observable changes in shoulder position, often held forwards, accompany this dislocation.

The rehabilitation plan comprises three phases. In Phase 1, spanning up to 6 weeks, the goal is to maintain anterior-inferior stability and ensure a safely progressive range of movement. Early isometric exercises are introduced, with pain levels not exceeding 3/10 on the self-perceived pain scale during the program. The second phase prioritizes early strength training, particularly in external rotation. The advanced phase involves more challenging exercises, incorporating weights and functional movements.

A comprehensive treatment approach may encompass various pain-relieving treatments, complementing the rehabilitation process. Musculoskeletal physiotherapists may employ additional assessments to track progress and determine appropriate treatment progression. Ongoing support and advice empower patients to self-manage and reduce the risk of future re-occurrence.

Q: My daughter is 10 years old and the doctors have diagnosed her with scoliosis. Please describe the condition.
A: Scoliosis is the deviation of the spine to the side (lateral deviation). It is commonly diagnosed in childhood or adolescence. To measure scoliosis. Although lateral deviation is highlighted in scoliosis, the element of rotation also adds to it.

The signs of scoliosis include lateral or sideways deviation of the spine, a sideways posture, shoulders not aligned and one of them being higher than the other, muscles aching, and pulmonary issues (the concern in progressing scoliosis). In several cases, patients have back pain, though the diagnosis needs to be thoroughly confirmed.

There are three types of scoliosis, 1: Idiopathic: In most of the cases (about 80%) if no cause is identified the condition is said to be idiopathic. It can also occur in adults especially old adults due to degenerative changes of the spine, it is common in adolescents and is further divided into Infantile scoliosis (the child is 0-3 years old), Juvenile scoliosis (the child is 4-10 years old, if the condition is not properly and timely treated, it can lead to cardiopulmonary issues. If the curve is more than 30 degrees it can progress and even require surgical procedures, Adolescent scoliosis (11-18 years of age).

2: Congenital scoliosis means that the condition is by birth, It may be due to any faulty or slow development of the spine at a location during pregnancy. 3: Neuromuscular scoliosis: The condition can develop as a complication of any neuromuscular condition like cerebral palsy, spina bifida, or muscular dystrophy.

For the diagnosis of scoliosis, a physical examination, an x-ray, MRI, or CT scan. Cobb’s angle is used to measure the angle of scoliosis which will further define the severity and progression. An Adam’s forward bend test and sociometry are also used. An examination is required to check whether the scoliosis is structural (no plasticity is found generally and the pathology lies in the spine) or non-structural (caused by any other factor or structure than the spine itself e.g. leg length shortening on one side).

The treatment is divided into conservative and medical or surgical. Patients who just have mild lateral deviations do not need any kind of treatment, in children however regular checkups are recommended because of their growing age. The conservative management includes braces and physical therapy, if a child has mild scoliosis and wears a brace, it will keep the condition from progressing but will not work to reverse the deviation.

Severe conditions require surgical procedures like a spinal fusion of some vertebrae, hence they lose movement and get fixed. In some cases when scoliosis is continuously progressing, a rod is placed in the spine.

A physical therapist can help with muscular strengthening, coordination, equilibrium, respiratory education, ergonomics, etc, and plan an exercise program for the patient.