Some aspects of “Carpal Tunnel syndrome” with homoepathic mode of treatment

Carpal Tunnel syndrome is an entrapment neuropathy of wrist. It is a disorder caused by compression at wrist of median nerve supplying hand, which causes tingling, numbness.
Sex- Women are more affected than men.

Age- Usually between 30 to 60 years.

Aetiology- Most cases are idiopathic. Trauma to wrist causing fracture or sprain, pregnancy, multiple myeloma, amyloidosis, rheumatoid arthritis, acromegaly or hypothyroidism all may play a role in the development of carpal Tunnel syndrome.

Risk factors-
(1) History of affection of any family member.
(2) Certain occupations.
(3) Stress.
(4) Obesity.
(5) Smoking.
(6) Oral contraceptives.
(7) Age over 40 years.

Associated medical conditions- Carpal Tunnel syndrome is sometimes associated with pregnancy, multiple myeloma, amyloidosis, rheumatoid arthritis, acromegaly or hypothyroidism.

Pathophysiology- Pressure on the median nerve due to a swelling or anything that makes the Carpal Tunnel smaller compresses the median nerve at wrist which in turn causes tingling, numbness, weakness or pain.

Clinical Features-
(1) The first symptoms to appear are usually at night during sleep & cause nocturnal tingling & pain in the hand & sometimes forearm.
(2) It may be followed by weakness of the thenar muscles.
(3) There may be wasting of abductor pollicis brevis with sensory loss of the palm & radial three & a half fingers which are supplied by the median nerve.
(4) Tinel Test - Taping on the median nerve or on the carpal tunnel if reproduces a shock or tingling in fingers is suggestive of Carpal Tunnel syndrome & Tinel Test is said to be positive.
(5) Phalen test – Flexion of wrist causes compression of median nerve in the tunnel with the result of paresthesia in the median nerve distribution, thus reproducing the patient’s symptoms.

Investigations- The diagnosis of carpal Tunnel syndrome is based primarily on symptoms & clinical findings. X-rays may be advised which would help in detecting any fracture in the wrist that may be the cause of carpal Tunnel syndrome. MRI can also be done for visualizing injury to median nerve. However, the most important diagnostic test for confirmation of the disease is median nerve conduction study which of course has some limitations because a small percentage of patients may have negative result in spite of features suggestive of carpal Tunnel syndrome while a small percentage of asymptomatic individuals have positive results. Besides these, ultrasound imaging, electromyography may also be done.

Differential Diagnosis- Carpal Tunnel syndrome may be confused with nerve compression caused by a cervical disk herniation, thoracic outlet structures. Pain due to osteoarthritis of 1st carpal-metacarpal joint may also simulate that due to carpal Tunnel syndrome.

Treatment-
[A] General measures to be taken are-
(1) Splinting or bracing.
(2) Modification of activity.
(3) Occupational therapy.
(4) Physiotherapy.

[B] Homeopathic medicines to be used – There are a lot of homeopathic medicines which can be used in the treatment of Carpal Tunnel syndrome. Causticum, Lycopodium, Apis, Calcerea carb, Ruta Graveolens (Ruta), Rhus toxicodendron (Rhus tox), Arnica etc can be used according to the presenting clinical features. Ruta may be used when there is pain & stiffness in wrists & hands, Causticum for numbness & loss of sensation in hands, Apis for numbness of hands & tips of fingers. Arnica is usually used when there is flare-up of inflammation or new injury caused by repetitive use of fingers & wrists. Rhus tox is useful when there are stiffness & pain which get worse on initial motion but improve as movement continues. Besides these, Lycopodium may be used if tingling & numbness is confined to the radial three & a half fingers with or without wrist swelling. Calcerea carb may also be used for tingling & numbness & swelling in wrist & the radial three & half fingers. The potency & frequency of dosage as well as duration of treatment varies with the severity of the condition & the individual. Lower potency is to be used at the beginning. If response is not satisfactory a second dose should be used. If desired effect is still not noticed, it is better to switch over to a new medicine.

Prevention-
(1) Reduction of obesity.
(2) Immediate treatment of any disease which may cause carpal Tunnel syndrome.
(3) Regular breaks from repeated hand movements to allow hands & wrists to take a rest.

Prognosis- Carpal Tunnel syndrome is usually not grave. With treatment pain subsides & there is usually no lasting damage to hand or wrist. When the condition occurs in pregnancy due to fluid retention it usually requires no treatment as it is self-limiting.

In short, carpal tunnel syndrome is manifested by tingling, numbness, weakness or pain in hand due to compression of the median nerve at wrist & is to be treated by Rhus tox, Ruta, Arnica, Causticum etc.

But in every case, a doctor should be consulted.

Some aspects of “Golfer’s elbow” with homoepathic mode of treatment

Also referred to as medial tennis elbow, Golfer’s elbow is a tendinopathy of the insertion of the flexors of the fingers of the hand & the pronators.
Epitrochleitis or Golfer’s elbow is very similar to lateral epicondylitis or tennis elbow but occurs on the medial side of the elbow, where the pronator teres & the flexors of the wrist & fingers originate. Tensing of these muscles by resisted wrist & finger flexion in pronation will provoke the pain.

Sex- Golfer elbow is most common in men.

Age- 20 – 50 years of age but the condition can affect anyone who repetitively stresses the wrist or the fingers.

Risk factors-
(1) Repeated or forceful movements of the fingers, wrist & forearm which causes repetitive strain on forearm flexors.
(2) Acute trauma may also play a role.

Pathophysiology- The flexor muscles of hand, wrist & forearm on excessive strain or over-use, may become irritated, inflamed & swollen. This causes pain & tenderness at the medial epicondyle of humerus. If not arrested at this point & allowed to progress, the tendon develops small tears in it at its attachment to the humerus.

Clinical Features-
(1) The most common symptom is pain & tenderness on inner side of elbow. The pain may occasionally extend along inner side of forearm. Onset of pain is usually gradual & aggravated by using the affected muscles while grasping objects or shaking hands. Tenderness is often less well localized than in tennis elbow.
(2) There may be a feeling of stiffness of elbow.
(3) Weakness of hands & wrists may also be there.
(4) Numbness or tingling sensation radiating into usaully ring & little fingers may be present.
(5) There will be pain on resisted forearm pronation with elbow extended or pain on resisted wrist flexion & these are the tests for clinical diagnosis.

Investigations- Golfer’s elbow is usually diagnosed clinically. X-ray of elbow is often done to rule out arthritis. MRI may be advocated if clinical diagnosis is difficult to be confirmed.

Differential Diagnosis- Golfer’s elbow is usually to be differentiated from Olecranon bursitis, Elbow arthritis, Carpal tunnel syndrome.

Treatment- It is the same as for tennis elbow but the treatment is even less satisfactory.
[A] General measures to be taken are-
(1) Rest.
(2) Restriction or total stoppage of activities causing pain.
(3) Elbow braces.
(4) Stretching exercises for flexor muscles which should be started after the disappearance of the symptoms of Golfer elbow. If there is any pain during or after the exercises, it should be stopped immediately.
(5) Physiotherapy.

[B] Homeopathic medicines to be used – Homeopathy may be used effectively in the treatment of Golfer elbow. If it is supposed to be due to overuse, Bryonia should be tried. Ruta Graveolens (Ruta) & Rhus toxicodendron (Rhus tox) are the medicines most commonly used. The potency & frequency of dosage as well as duration of treatment varies with the severity of the condition & the individual. Besides these, if it is supposed to be due to any previous injury, Arnica can be very effectively used. On the other hand, if it is supposed to be due to overuse, Bryonia may be tried.

Prevention-
(1) Modification of activities or particular techniques that lead to the development of this overuse injury.
(2) Guidance of a coach for sporting activities may often be helpful.

Prognosis- Golfer elbow is usually a self-limited problem which is quite unlikely to cause any long-term health hazard. With athletes a change in technique often resolves the problem. Life style modification is to be considered if Golfer elbow does not resolve or if it recurs.

In short, Golfer’s elbow is manifested by pain & tenderness on the medial side of the elbow & is to be treated by Rhus tox, Ruta, Arnica etc.

But in every case, a doctor should be consulted.

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.
(1)Novice.
(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.

Signs-
(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.

Treatment-
[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.

Prevention-
(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.

Some aspects of “Housemaid’s knee” with homoepathic mode of treatment-

Also known as roofer’s knee, it is a benign swelling over the knee on account of an enlargement of the bursa named prepatellar bursa in front of the patella, which in turn is due to an inflammation of the said bursa. Housemaid’s knee is so named because of the fact that this health problem was once found to be a major occupational hazard of Housemaid’s knee & was believed to be caused by leaning too much on the knee by them.

Pathology- Prepatellar bursa is a superficial bursa with a thin synovial lining in front of the patella in between the skin & the patella. It is seen in the lower half of patella & upper half of ligamentum patella. The bursa develops after birth within a few years of life as a result of mechanical pressure & friction. It helps in reducing friction on the underlying structures & thus allows maximal range of motion in the knee. The inflammation of the bursa usually due to repeated trauma to the knee with excess fluid causes restricted movement of the joint with pain, swelling & heat.

Age- Any age group can be affected.

Sex- It is more common in males.

Predisposing factors-
(1) Repeated rubbing or pressure on the knees from kneeling on hard surfaces in an occupation.
(2) A direct blow or a fall on the knee causing rupture of blood vessels & subsequent swelling of the prepatellar bursa.
(3) Spread of an infection from a surface injury, such as a skin wound over the kneecap. Infection is usually the main cause of Housemaid’s knee in children. Infection is also the main cause in people in whom the immunity is deranged such as those on steroid therapy or chemotherapy for cancer.

Clinical features-
(1) Swelling over the kneecap.
(2) Warmth over the kneecap.
(3) Limited motion of the knee.
(4) Painful movement of the knee.
Kneeling usually aggravates the symptoms, while sitting still relieves them.

Treatment-
[A] General measures to be taken are-
(1) Avoidance of the aggravating activity.
(2) Wearing of knee pads while kneeling.
(3) Exercise to strength the quadriceps muscle.
(4) Physiotherapy.

[B] Homeopathic medicines to be used are- Specific remedies include Arnica, Bryonia or Ruta graveolens (Ruta)। The potency & frequency of dosage varies with the severity of the condition & the individual। Usually a lower potency 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. It is to be kept in mind that Housemaid’s knee caused by infection needs to be recognized quickly & treated promptly.


Prevention- Use of knee pads by those whose work necessitates kneeling for extended periods of time. This is especially true for those who had already an episode of Housemaid’s knee to prevent recurrence.

Prognosis- Housemaid’s knee may interfere with physical activity, but otherwise it is relatively harmless. But if left untreated, there may be associated loss of quadriceps muscle strength which in turn may cause the leg to give out.

In short, Housemaid’s knee manifests itself as a swelling over the kneecap & can be treated by Arnica, Bryonia or Ruta.

But in every case, a doctor should be consulted.