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Thursday, May 14, 2009

Some aspects of “Tennis Elbow” with homoepathic mode of treatment

Also referred to as ‘Lateral epicondylitis’, Tennis elbow is an eponym given to many painful conditions about the elbow & is the pain & tenderness on the lateral side of the elbow, some well defined & some vague that results from repetitive stress. Because people who play tennis or other racquet sports sometimes develop this condition due to faulty playing technique, it is known as “tennis elbow”. Tennis elbow usually affects the dominant arm but it can also occur in the nondominant arm or both.

Seen in-
(1)All levels of tennis players in whom ‘Backhand Stroke’ appears to be the prime cause in most of the players but ‘SERVE’ also plays a role.
(2) Seen in other sports also.
(3) May be occupational etc.

Causes in tennis players-A majority of tennis players all over the world are affected with this problem over 35 years of age.
(2)Excessive playing of games per week.
(3) Age over 35 years.
(4) Equal sex incidence.
(5)Backhand stroke appears to be the cause in most of the players followed by ‘SERVE’.
But ‘Forehand stroke’, ‘Backhand volley’, ‘Overhead smash’, or ‘Forehand volley’ may play a role.

Contributing factors in tennis players-
(1) Little playing experience.
(2) Consistent missing of ‘sweet spot’ while hitting.
(3) Poor stroke techniques: use of arm instead of body.
(4)Poor power or flexibility.
(5)Heavy stiff racket, large handle size, too tight racket stringing.
(6)Heavy duty wet balls.
(7)Playing surface-balls bounce quicker off the cement court (quicker bouncing like Playing surface).

Sex-It affects men more than women.

Age-It affects people between ages of 30 & 50, although people of any age can get it.

Site of lesion-Lateral tennis elbow involves the common tendon to the extensor muscles of the wrist & hand. The tendon of the extensor carpi radialis brevis has been identified as the most common site of the lesion.

Clinical Features-
Symptoms-At the very beginning due to acute inflammation, the patient complains of pain during activity. The pain is very soon felt both during activity & at rest due to chronic inflammation. Ultimately the patient complains pain at rest, & pain during daily activities & even night pains.

(1) Local tenderness over the lateral humeral epicondyle at the common extensor origin with aching pain in the back of the forearm.
(2) Extension of the wrist against resistance with elbow in full extension elicits pain at the outside of the elbow.
(3) Passive wrist flexion & pronation with elbow in extension produces pain.

Investigations- Tennis elbow cannot be diagnosed from blood tests. Radiographs only rarely reveal soft tissue calcification near the lateral humeral epicondyle, & MRI is of questionable aid in making the diagnosis. It is rather usually diagnosed by description of pain & certain findings from physical exam. However, MRI has been shown to be helpful in diagnosing cases of early Tennis elbow.

Differential Diagnosis- Other causes for lateral elbow pain should be considered, including radiocapitellar arthritis & posterior interosseous nerve compression,elbow arthritis, radial tunnel syndrome etc.

[A] General measures to be taken are-
(1) Rest.
(2) Restriction or total stoppage of activities causing pain.
(3) Avoidance of lifting of heavy items especially with palm facing downwards.
(4) Wrapping of a band around forearm near the elbow.
(5) Wearing of a wrist splint.
(6) Exercises to stretch & strength the wrist extensor muscles. But exercise should be started when healing has occurred to the level that the exercises do not increase pain.
(7) Physiotherapy.
(8)In tennis players exercises, light racket, smaller grip, elbow strap etc are helpful.

[B] Homeopathic medicines to be used – Homeopathy plays a vital role in treatment of Tennis elbow. Constitutional treatment is essential specific remedies include Ruta Graveolens (Ruta) & Rhus toxicodendron (Rhus tox). If it is due to any previous injury, Arnica can be very effectively used. If it is supposed to be due to overuse, Bryonia should be tried.

(1) Correct technique of play to be adopted, backhand stroke to be played with whole body & not just with the wrist.
(2) Use of a forearm brace wrist or elbow is weak.
(3) Wet, heavy balls should always be avoided.
(4) Use of a light racket in case of an occasional player.
(5) Strings should not be too tight.
(6) Activities requiring repetitive wrist & forearm motion should be avoided.
(7) Change in size or type of tennis racquet or tool may be helpful.
(8) Change of occupation to prevent further injury may also help in some cases.

In short, Tennis elbow is manifested pain & tenderness on the lateral side of the elbow & is to be treated by Rhus tox, Ruta, Arnica etc.

But in every case, a doctor should be consulted.

Wednesday, May 13, 2009

Some aspects of “Dequervain’s disease” with homoepathic mode of treatment

It is a stenosing tenovaginitis of the tendons in thumb.

Sex- Women are more prone to this disease compared to men.

Age- Mostly found between ages of 30 & 50 years but anyone at any age can get it.

Aetiology-Exact cause is not known. It may be due to repeated overuse of the wrist. A direct blow to the thumb, & certain inflammatory conditions can trigger the disease.

Associated medical conditions- Pregnancy, diabetes mellitus, osteoarthritis, or rheumatoid arthritis.

Pathophysiology-There is apparently spontaneous thickening of the common sheath of abductor pollicis longus, extensor pollicis brevis tendons at the wrist & the consequent result is the entrapment of the tendon. The swollen tendons & their coverings rub against the narrow tunnel through which they pass. The result is pain at base of the thumb.

Clinical features- Presentation may be gradual or sudden. Pain along back of the thumb is the most common symptom. Thumb motion may be difficult & painful, particularly when grasping objects. There may be tenderness & swelling over the thumb side of wrist. Pain may be raised with movements of the thumb & wrist. Tenderness can be elicited by sudden ulnar deviation of the flexed hand. It is the surest sign for diagnosis of Dequervain’s disease & is known as Finkelstein’s test.

Investigations- No X-rays or laboratory investigations are usually needed for its diagnosis. But blood sugar examination to rule out diabetes mellitus & other investigations to see the presence of associated medical conditions like rheumatoid arthritis etc or any other pathology causing the symptoms are to be done.

Differential Diagnosis- Dequervain’s disease is to be differentiated from osteoarthritis of 1st carpo-metacarpal joint, Carpal Tunnel Syndrome, Intersection Syndrome etc.


[A] General measures to be taken are- Besides treatment of the associated medical conditions, if any the following should be done-
(1) Rest.
(2) Limitation of activities that aggravate the condition.
(3) Occasionally a splint on the affected hand to restrict the joint movement.
(4) Exercise.

[B] Homeopathic medicines to be used – Ruta Graveolens (Ruta) & Rhus toxicodendron (Rhus tox), can be very effectively used as its remedy. The potency & frequency of dosage as well as duration of treatment varies with the severity of the condition & the individual.

Prevention- Prevention consists of avoidance of excessive movements such as hand & wrist twisting, pinching & forceful gripping.

Prognosis- Majority respond well with treatment if started early.

In short, Dequervain’s disease is a stenosing tenovaginitis which is manifested as pain, tenderness & swelling over the thumb side of wrist & is treated by Ruta & Rhus tox.

But in every case, a doctor should be consulted.