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Sunday, February 22, 2009

Some aspects of “Bursitis” with homoepathic mode of treatment

Bursitis is inflammation of a bursa. A bursae is a cushion like sac lined with membrane similar to synovium which is located between a tendon & a bone thus reducing friction between them & allowing the tendon to glide easily over the bone. When subjected to repeated pressure due to over & abnormal use it gives rise to bursitis.

Site of lesion-
Bursitis most often occurs in –
(1) Shoulder .
(2) Elbow.
(3) Knee.
(4) Hip.

Causative factors-
(1) Overexertion of a joint. The repeated motion of a joint causes friction in the bursa. Subsequently, with continuation of activity, the bursa becomes inflammed & filled with fluid. The bursa thickens & does not function well. Both the bursa & the tendon become irritated.
(2) Occasionally a bursa will become infected by haematogenous spread or due to open trauma to the overlying skin or blow to an area containing a bursa.

Clinical features-
Presentation -The patient presents with complain of pain, stiffness of a joint along with malaise & possibly fever.
(1)Pain, tenderness & redness of the area of the affected bursa .
(2) Swelling & warmth around the area of the bursa.
(3)Restricted movement of the nearby joint with the subsequent result of restricted function of the affected limb.

Differential Diagnosis- Bursitis has to be differentiated from acute exacerbations of rheumatism & flare-ups of gout both of which clinically manifest with significant erythema & swelling.

[A] General measures to be taken are-
(1)Rest to the affected area & protecting the area from any kind of trauma.
(2)Exercise & application of heat.
(3) Stopping of the activity causing pain if the bursitis is a chronic one.
Homeopathic medicines to be used are-
Benzoicum acidum ( It acts well when the pain is tearing with stitches & the adjacent joint cracks on movement.
Bryonia- It may be used when the adjacent joint is stiff & painful & the pain is of stitching or tearing type & becomes worse from even the slightest motion.
Belladonna (Bell)-It acts well when there is shooting pain along limbs.
Rhus tox -This remedy is particularly helpful where there is pain on initial movement which gradually improves with movement. The pain may also be worse during sleep & in the morning on waking.
Silicea (Sil)- It acts well when the pain seems to be tightly bound & the sensation seems to be suppurating. Ruta graveolens(Ruta) – This remedy is particularly useful for bursitis after any injury. It is also helpful in acute bursitis with great stiffness & aching pain.

Some points to be kept in mind-
(1) The potency & frequency of dosage varies with the severity of the condition & the individual. Usually a lower potency like 30C is to be used first for thrice daily & to be continued till the persistence of the symptoms. If improvement is seen, the same medicine is to be continued. But if there is no significant improvement or improvement has come to a standstill, the frequency of dosage should be increased. And in cases where there is no response within a reasonable amount of time, the medicine should be stopped & a different medicine is to be started.
(2) If bursitis is caused by an infection, the infection should be combated first in addition to treatment of bursitis.
(3) If bursitis is related to any inflammatory condition such as arthritis, or gout, the disease is to be treated also for control bursitis.

(1)Wearing of protective pads if participating in contact sports.
(2)No overdoing of any kind of sports & activities & that too to be done correctly.

Prognosis- In general, bursitis has a favourable result if treated early but if the underlying cause is not removed properly it may develop into a chronic condition.

In short, bursitis manifests itself as a tender, warm, swelling adjacent to a joint & can be treated by Benz।ac, Bryonia, Rhus tox, Ruta or Silicea.

But in every case, a doctor should be consulted.

Sunday, February 15, 2009

Some aspects of Ganglion with homoepathic mode of treatment

A ganglion is a localized, tense, painless, cystic, swelling, containing clear gelatinous fluid. It is the most common soft-tissue tumour of the hand & wrist.

Pathology- The cystic structure of ganglion is formed from the lining of a joint or tendon & is filled with a gelatinous fluid but without any synovial or epithelial lining. A stalk can sometimes be identified communicating between the cyst & an adjacent joint or tendon sheath.

Sex- Ganglion formation is more common in females.

Age-Late teens & young adulthood.

Sites of location- It is commonly seen over the wrist, digital flexor sheath & distal interphalangeal joint, but it can also develop on the shoulder, elbows & knees.

Predisposing factors- Chronic repetitive stress & sometimes injury. Occupational factors may play a vital role in its development. The occupations which require overuse of certain joints such as the wrist, may pose a risk for development of ganglion.

Associated diseases- Some joint diseases like Rheumatoid arthritis are occasionally found to be associated with ganglion.

Clinical features- Ganglion presents itself usually as a painless swelling adjacent to a joint or a tendon mostly on the wrist, especially on the back side & fingers. It is usually asymptomatic & is primarily a cause of cosmetic rather than a functional disturbance to the affected person. The condition, however, may become symptomatic if the ganglion presses on any nearby structure such as an artery, vein, tendon or nerve when the impingement of such a structure may cause pain, triggering of a tendon or vascular compromise. If a nerve is pressed upon, the resulting pain may cause restriction of movements & activity of the affected person. Dorsal wrist ganglion which is most commonly encountered may be small when it is barely palpable but is usually highly symptomatic whereas if it is large it is often soft & only mildly symptomatic. Flexor sheath ganglion may present as a firm mass over the palmar aspect of the flexor sheath & is often confused with a bone exostosis due to its severe degree of firmness.

Differential Diagnosis- Ganglion may have to be differentiated from certain conditions. A few of them are-

(1) Fibroma.
(2) Lipoma.
(3) Neuroma.
(4) Hamartoma.
(5) Tenosynovitis.

Treatment- Homeopathy medicine improves re-absorption of fluid from the ganglion & thus cures the condition. In addition chance of recurrence is minimal. Favourable results are usually noticed within 3-6 months. Treatment should be followed till it subsides wholly; otherwise there is chance of recurrence. Calcarea Fluorica (Calc flour) 200 twice daily or Ruta Graveolens (Ruta) 200 twice daily may be used. Ruta may also be used as a local application over the site of ganglion formation. Other medicines which can also be used include Rhus toxicodendron (Rhus tox), Benzoicum acidum (, Thuya etc.

Prognosis- Ganglion may increase in size or may disappear spontaneously.

In short, ganglion is a painless, cystic swelling found near a joint or a tendon & is treated by Calcarea fluorica or Ruta.

But in every case, a doctor should be consulted.

Sunday, February 8, 2009

Some aspects of Frozen Shoulder with homoepathic mode of treatment

Frozen shoulder is defined as a clinical syndrome characterized by painful restriction of both active & passive shoulder movements due usually to no intrinsic cause within the shoulder . In India the problem is compounded by the increasingly sedentary life styles & general lack of exercise.

Sex- Females are affected at a slightly higher rate than males.

Laterality- Usually unilateral with the involvement of the non-dominant arm, but a percentage of patients develops the disease bilaterally.

Cause- Frozen shoulder is caused by tightening of the soft tissues, that surround the shoulder joint & gets worse over time

Risk factors-
Factors directly related to shoulder joint- A few of them are -
(1) Injuries to the shoulder like fractures & dislocations around the shoulder.
(2) Tendinitis of rotator cuff.
(3) Bicipital tendonitis.
Factors not directly related to shoulder joint- A few of them are –
(1) Diabetes mellitus, especially insulin-dependent type. Diabetics on insulin therapy for many years are more prone to this disease & have a greater chance of having bilateral involvement.
(2) Thyroid irregularities.
(3) Disc problems in neck.
(4) Illness especially heart and /or lung disease or injury that forces to keep the shoulder immobile for a period of time.

Clinical features- There is a gradual limitation of external rotation & abduction movements of the shoulder with pain more marked at night. The pain is usually dull or aching & is worsened with attempted motion. The pain is usually located over the outer shoulder area & sometimes the upper arm. The patient can not dress himself or comb the hair or scratch the back. Gradually stiffness & pain increase to freeze all the movements of shoulder with wasting of surrounding muscles. The hallmark of the disorder is restricted motion or stiffness in the shoulder. Fortunately, pain progressively decreases from the initial, inflammatory phase. With time, patients are able to use the shoulder with little or no pain, within the restricted range of motion, but attempts to exceed this range are accompanied by pain. The overall course is variable but can last 12-36 months.

(1) Blood sugar estimation both fasting and post-prandial to detect associated diabetes mellitus.
(2) Blood for T.S.H, T3, T4 to exclude any thyroid irregularities.
(3) X-ray – It may show decalcification, loss of joint space.
(4) Arthrography- Radiographic confirmation may be done by it। Compared to the normal capacity of 12ml, there may be marked reduction in the capacity of the joint & often the affected shoulder may not take more than 2-3 ml of dyए.

(5) MRI-MRI may be indicated but is not of much use.

Differential Diagnosis- Frozen shoulder is to be differentiated from the following diseases-
(1) Rheumatoid arthritis which may affect the shoulder but it is more likely to affect the small joints of hands or feet.
(2) Osteo arthritis which may sometimes develop in the shoulder but it is more common at the nearby acromioclavicular joint or in neck.
(3) A tear in rotator cuff muscles of the shoulder with development of shoulder pain & disability but it has a high prevalence in those with athletic activities & has a past history of significant shoulder injury.
(4) Serious diseases like cancer or infection but these are very rare around the shoulder.

Treatment- Treatment should be started before stiffness develops.
A] Exercises & physiotherapy- Active exercise of the shoulder like raising the arm against a wall, circumduction movement in a stooping posture is advised. Physiotherapy consisting of short wave diathermy, ultrasound etc may be continued. It should be kept in mind that active exercise is the mainstay of treatment for frozen shoulder & should be continued at least till the disappearance of the symptoms but is better to continue as long as possible even after the disappearance of the symptoms to prevent any further involvement.
B] Homeopathy- Treatment should be constitutional but specific remedies may include Bryonia (Bry) 30 & Rhus toxicodendron (Rhus tox) 30.
(1) Bryonia (Bry) - Bryonia is suitable effective in those who are suffering from severe pain, especially stitching & tearing in nature, made worse by slightest motion, compelling the patient to keep still & felt better by rest.
(2) Rhus tox 30-Rhus tox is suitable for those who have a feeling of stiffness & are suffering from tearing pain which has a tendency to spread & is worse after rest or inactivity but gradually diminishes on moving the shoulder .
Alternate use of Bryonia 30 & Rhus tox 30 with a gap of 3 hours between each dose, starting with Bryonia 30 so that each medicine is taken three times a day. The medicines should be continued till the disappearance of the symptoms & then continued for a couple of days more with a reduced number of dosage.
Besides these the following may also be tried-
(a) Sanguinaria 30 may be used in right-sided frozen shoulder where pain is worse from movement of the shoulder & better by rest & sleep.
(b) Chelidonium 30 may also be used when the pain affects the arm, shoulder, hand & tips of fingers & is made worse from movement of the shoulder as well as on touching but better from pressure or massage.

(1) Regular performance of ‘range of motion exercises’ to maintain a strong & flexible shoulder.
(2) To have prompt treatment for a shoulder injury.
(3) To engage in activities that use the shoulder joint regularly.
(4) To maintain normal movements of the shoulder through a full range several times a day after any injury to the upper extremity like hand, wrist, elbow etc or even after being confined to bed.

Prognosis- In most patients, the condition improves spontaneously 1–3 years after onset। While pain usually improves, most patients are left with some limitation of shoulder motion.

In short, Frozen Shoulder is manifested by pain & stiffness of the shoulder with limitation of both active & passive movements & is treated in homeoepathy with alternate dosage of Bryonia 30 & Rhus।tox 30.

But in every case, a doctor should be consulted.