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.

Treatment-

[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.
(5)Physiotherapy.

[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.

Some aspects of “Trigger finger” with homoepathic mode of treatment

Also known as ‘Flexor Tenosynovitis’, it is a stenosing tenovaginitis, in which the sheath of a flexor tendon thickens, apparently spontaneously, so as to entrap the tendon. It is more common in dominant hand & most often affects the thumb or middle or ring finger.

Sex- More common in women than men.

Age- Occur most frequently between the ages of 40 to 60 years.

Aetiology-Exact cause is not known. It is usually found in those with repetitive gripping actions. Diabetics are also more prone to this disease. Diabetics can have several fingers involved.

Aggravating factors- Prolonged, strenuous grasping may aggravate the condition.

Associated medical condition- Rheumatoid arthritis, gout, hypothyroidism, amyloidosis, diabetes mellitus.

Pathophysiology-The protective sheath surrounding the tendon in the affected finger if becomes inflammed due to any cause, the space within the tendon sheath may become narrow & constricting। As a result, the tendon cannot glide through the sheath easily & at times there is catching of the finger in a bent position। With each catch, the tendon itself becomes irritated & inflammed, worsening the condition। With passage of time inflammation becomes prolonged & there is scarring & thickening & occasional formation of nodules. As a result the gliding of the tendon becomes more difficult & the tendon may momentarily be stuck at the mouth of the sheath as the finger is extended. A pop may be felt as the tendon slips past the tight area. This causes pain & catching as the finger is moved.

Presentation- Pain & limitation of the movements of the involved tendons are the presenting features.

Clinical features- Patients frequently note catching or triggering of the affected finger or thumb after forceful flexion। In some instances, the opposite hand must be used to passively bring the finger or thumb into extension. In more severe cases, the finger may become locked in a flexed position. Triggering is often more pronounced in the morning than later in the day. Stiffness & catching tend to be worse after inactivity. A nodule or tenderness is noticed at the base of the affected finger. The nodule generally moves with finger flexion & extension.

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, gout are to be done. Blood sugar estimation is particularly essential if multiple fingers are involved.

Differential Diagnosis- Trigger finger may be confused with Dupuytrens contracture, Carpal tunnel syndrome, Rheumatoid arthritis etc.

Treatment-

[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.
(5) Physiotherapy.

[B] Homeopathic medicines to be used – Ruta Graveolens (Ruta) is the specific remedy which is very effective as its remedy. The potency & frequency of dosage as well as duration of treatment varies with the severity of the condition & the individual

Prevention-
(1) Avoidance of repetitive grasping & releasing of objects.
(2) Modification of activity if it can not be avoided.
(3) Proper selection of tools for the job.
(4) Minimization of repetition. Periodical rest of the hands briefly during repetitive or stressful activity.
(5) Frequent stretching during repetitive activity.

Prognosis- Trigger finger can be effectively managed with homeopathy if treatment is started at the beginning। But patients with diabetes mellitus have a lower response rate.

In short, Trigger finger is a stenosing tenovaginitis which is manifested as a painful condition where a finger or thumb locks when it is bent or straightened & is treated by Ruta.

But in every case, a doctor should be consulted.

Some aspects of “Achilles tendonitis” with homoepathic mode of treatment

Achilles tendonitis is the inflammation (tendonitis) of the Achilles tendon which is the thickest & strongest tendon in the body connecting the heel to the calf muscles & thus enables a person to stand on the toes, to walk, to run or to jump. Achilles tendonitis is a frequent complaint in athletes, especially runners training under less than ideal conditions.

Causes- Lack of flexibility & overpronation are the two basic causes. Associated causes may be the following-

[A] Extrinsic-
(1) Repetitive stresses to the tendon.
(2) Overuse.
(3) Overtraining.
(4) Poor conditioning.
(5) Improper training surfaces.
(6) Improper stretching exercises.

[B] Intrinsic-
(1) Age.
(2) Tight Achilles tendon.
(3) Different congenital foot & knee deformities.
(4) Medical diseases affecting tendon tissue like diabetes mellitus.
(5) Use of long continued steroids.

Clinical features-
(1) Pain over & above the back of the heel which increases on participation in activities especially after a period of inactivity. Hence patients complain of pain after first walking in the morning & also on running or jumping.
(2) Tenderness over the Achilles tendon.
(3) Stiffness of the tendon in the morning which gradually lessens as the tendon warms up.
(4) Inability to stretch Achilles tendon without pain.
(5) Mild swelling on the tendon.
(6) Occasionally a cracking sensation when the tendon is under pressure.

Investigatins-
(1) Blood Tests- Routine Blood Tests for sugar estimation to exclude diabetes mellitus.
(2) X-rays- X-ray is not useful but should be done as a routine to find out other possible conditions.
(3) MRI- MRI is helpful in evaluating a patient for tears within the tendon. It also can provide useful information in refractory cases & helps in preoperative evaluation & planning in patients being considered for surgery.

Differential Diagnosis- Achilles tendonitis may sometimes be confused with Achilles tendon rupture, Ankle Sprain, Ankle fracture, Retrocalcaneal bursitis, Athletic foot injuries, Achilles bursitis, Deep venous thrombosis, etc

Treatment-

[A] General measures to be taken are-
(1) Rest.
(2) Wearing of a heel pad that slightly raises the heel.
(3) Exercises to strengthen the tendon.

[B] Homeopathic medicines to be used- Homeopathy can be very effective if properly used. Homeopathic medicines to be used depend on the clinical features & the causative factors. Ruta Graveolens (Ruta), Thuya, Benzoicum Acidum (Benz.ac) etc. may be used. The potency & frequency of dosage as well as duration of treatment varies with the severity of the condition & the individual

Prevention-
(1) Warming up & stretching before any sort of sport.
(2) Strict restriction of overdoing of any sport.
(3) Wearing of correct footwear.
(4) Designing of shoes according to the sport with adequate heel support.

Prognosis- Achilles tendon having a poor blood supply is slow to heal. But with proper treatment the affected tendon usually recovers completely, provided treatment is started in time. In case the starting of treatment is delayed, it may develop into a chronic one. With passage of time the inflammation may lead to degenerative changes within the tendon & may even lead to small tears within it which make it susceptible to rupture. Incomplete rehabilitation or a hasty return to activity should be strictly prohibited as it would hamper the healing process & may also lead to re-injury.

In short, Achilles tendonitis is the inflammation of the Achilles tendon which is manifested as pain, tenderness & stiffness of the tendon that increases on participation in activities especially after a period of inactivity & is treated Ruta, Thuya, Benz.ac etc.

But in every case, a doctor should be consulted.

Some aspects of Internal Hordeolum with homoepathic mode of treatment-

It is the suppurative inflammation of a meibomian gland of exactly same nature as stye but is comparatively rare. It is often called a suppurative chalazion and sometimes may be due to secondary infection of a chalazion.

Causative agent- Staphylococcus.

Symptoms-They are same as for stye but are more severe.

Signs-
(1) A tender, painful swelling within the substance of the lid in the tarsal plate, a little distance away from the lid margin.
(2) The point of maximum tenderness is away from the lid margin.
(3) If the lesion enlarges, the pus points on the tarsal conjunctiva and not on the root of an eyelash. It rarely points on the skin.

Treatment-
(1) Lid hygiene should be properly maintained.
(2) Blood sugar should be controlled in case of diabetes mellitus.
(3) General health of the patient should be improved with good nutrition and vitamins.
(4) Refractive errors, if any, should be corrected with suitable glasses (spectacles) or contact lenses।

(5) Hot compresses may be applied.
(6) Homoeopathy plays a good role in its treatment. Of the different medicines, Hepar Sulph (Hepar Sulphuris Calcareum) 30 should be given six times daily for a week if there is intense pain. Silicea 30 may also be used & should be given six times daily for a week if the pain is stitching in nature.

Labels-Blood sugar, Chalazion, Conjunctiva, Contact lens, Diabetes mellitus, Hepar Sulph (Hepar Sulphuris Calcareum), Eyelash, Glass, Health, Homoeopathy, Refractive errors, Spectacle, Hygiene, Internal Hordeolum, Nutrition, Patient., Pus, Silicea, Skin, Vitamin.

IN SHORT- Internal Hordeolum is manifested as a tender, painful swelling within the substance of the lid a little distance away from the lid margin. Treatment is followed as mentioned above.

But in every case, a doctor should be consulted.

Some aspects of External Hordeolum or Stye with homoeopathic mode of treatment -

External hordeolum or stye is a focal, acute inflammation of the follicle of an eyelash including the glands of Zeis or Moll, usually ending in suppuration.

Causative agent- Staphylococcus.

Associated Conditions- It may be associated with blepharitis, rosacea or seborrhoeic dermatitis.

Associated factors- It may be associated with uncorrected errors of refraction as well as some metabolic factors like diabetes mellitus, debility & excessive intake of carbohydrate.

Age- It may occur at any age, but more common in adults than in children.

Symptoms- Acute pain in the lid margin with a sense of heaviness & heat.

Signs-
(1) A single or multiple swellings at the margin of the affected lid pointing anteriorly through the skin.
(2) Marked tenderness at the point of inflammation on the lid margin.
(3) Swelling, redness & marked oedema of the affected lid as a whole.
(4) Congestion of the neighbouring conjunctiva which may be chemotic.
(5) Enlargement of the corresponding pre-auricular lymph glands.
(6) Finally appearance of a white pus point on the lid margin at the base of a cilium which indicates suppuration.

Course- If not treated, the pus point may burst outside & consequently the pain and swelling subsides.

Complications- Usually none but very rarely the inflammation may spread producing cellulitis of the orbital tissue.

Treatment-
(1) Lid hygiene should be properly maintained.
(2) Blood sugar should be controlled in case of diabetes mellitus.
(3) Refractive errors, if any, should be corrected with proper glasses (spectacles) or contact lens.
(4) General health of the patient should be improved with good nutrition and vitamins.
(5) Hot fomentation should be applied on the lid to hasten suppuration.
(6) If the pus points on the skin of the lid, the pus should be drained by pulling out the affected eyelash.
(7) Homoeopathy plays a good role in its treatment. Of the different medicines, constitutional medicine is Graph (Graphites) 200 for fair, fatty, flabby patients. General medicine is Staphysagria 200 twice daily. If there is severe pain, Hepar Sulph (Hepar Sulphuris Calcareum) 30 should be added with it till the pain persists in a dose of four times daily. If there is stitching pain, Silicea 200 should be added with the general medicine till the persistence of the pain. General medicine should be continued till the subsidence of stye and also for another two weeks.

Labels- Homoeopathy, Diabetes mellitus, Nutrition, Vitamins, Refractive errors, Glasses, Spectacles, Blepharitis, Rosacea, Seborrhoeic dermatitis, Swelling, Oedema, Lymph gland, Inflammation, Suppuration, Blood sugar, Health, Eyelash, Pus, Conjunctiva, Treatment, Staphylococcus, External Hordeolum, Stye, Graphites, Silicea, Hepar Sulph, Staphysagria.

IN SHORT- Stye is manifested as a single or multiple swellings at the margin of the eyelid with marked tenderness along with swelling, redness & oedema of the affected lid as a whole. Treatment is followed as mentioned above.

But in every case a doctor should be consulted.