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 “Baker’s Cyst” with homoepathic mode of treatment

Also known as a ‘Popliteal Cyst’, Baker cyst is a distended bursa caused by knee joint fluid protruding to the back of the knee. It is thus a benign swelling & is named after Dr William Morrant Baker who first described this health condition. The term is a misnomer as it is not a true cyst but is due to synovial fluid distending the bursa.
Aetiology-
(1) Idiopathic- Baker cysts may sometimes develop without any apparent cause particularly in children.
(2) Infection- Local infection may cause a retention of fluid with the subsequent formation of a Baker cyst.
(3) Trauma or injury to the knee- It may cause an effusion, thus triggering the formation of a Baker cyst.
(4) Arthritis-Arthritis is the most common & osteoarthritis probably the most frequent among arthritides.
(5) Internal derangement of knee- Internal derangement of knee like meniscal tears etc. may cause an effusion resulting in the formation of a Baker cyst.

Location- It is located posterior to the medial femoral condyle, between the tendons of the medial head of the gastrocnemius & the semimembranosus muscles.

Age- Baker cysts appear much less frequently in children than in adults.

Pathology- Being an extension of the knee joint, a Baker cyst is a synovial cyst lined with a true synovium. In most cases herniation of synovial membrane through posterior part of capsule takes place. . Escape of fluid through the normal communication of bursa with knee is the other mode. The knee joint effusion caused by intrinsic intra-articular disorders or any other cause is displaced into the popliteal bursa, thus reducing potentially destructive pressure in the joint space. So a Baker cyst may have a protective role to play for the knee. In such cases, the popliteal bursa becomes filled up with fluid & consequently expands resulting in the formation of a swelling. The cyst usually communicates with the joint by way of a slit-like opening or may pinch off.

Associated health conditions-Medical conditions associated with Baker cysts are as follows-
(1) Arthritis is the most common among which osteoarthritis is the most important. Rheumatoid arthritis, Juvenile rheumatoid arthritis etc are also common.
(2) Internal derangement of knee like meniscal tears etc.
(3) Infection like septic arthritis.
(4) Miscellaneous- Hypothyroidism, Gout, Psoriasis, Systemic lupus erythematosus, Sarcoidosis, Haemophilia, etc.

Clinical features- May be asymptomatic or may have the following features in addition to the features of the underlying primary cause-
(1) A slight swelling behind the knee which is particularly noticeable on standing & when compared to the opposite uninvolved knee.
(2) The swelling is usually soft & fluctuant & is with or without pain. Typically these cysts are not painful unless swelling is extensive.
(3) A sensation of tightness behind the knee, especially when the knee is extended or fully flexed.
(4) Restricted mobility of the knee joint.
(5) Transillumination- Transillumination by a shining light through the cyst may show a mass filled with fluid.
(6) In case there is rupture of the cyst, calf tenderness & bruising at the ankle may be present.

Investigations-
(1) X-ray- An X-ray of the knee joint will not show any cyst, but it may show the presence of other abnormalities which may cause development of a Baker cyst.
(2) MRI- An MRI helps to show a cyst with its size & location.
(3) Ultrasound- An ultrasound can also determine the location & contents of a cyst.
(4) Arthrogram- Arthrograpgy may also be utilized for its detection & it is more sensitive than ultrasonography in its detection.

Complications- A Baker cyst may sometimes compress vascular structures & may cause a deep vein thrombosis. It may also rupture & cause extravasation of fluid in the calf. There may also be haemorrhage into the cyst in some cases, particularly if there is any associated bleeding disorder. Infection in case of a Baker cyst is very rare.

Differential Diagnosis- A Baker cyst may sometimes be confused with thrombophlebitis or deep vein thrombosis from which it is to be differentiated by urgent blood tests & other investigations. It may also sometimes be confused with septic arthritis or a ganglion cyst.

Treatment-
[A] General measures to be taken are-
(1) Treatment of underlying cause like arthritis or torn knee cartilage.
(2) Temporarily avoiding activities that may increase the load on the knee joint. (3) Physiotherapy.
(4) Exercises to maintain mobility & strength of the knee joint.
[B] Homeopathic medicines to be used – Homeopathy can be very effective if properly used. Homeopathic medicines to be used depend on the size of the cyst along with its cause & the symptoms produced. Ruta Graveolens (Ruta), Rhus toxicodendron (Rhus tox), Bryonia 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- Prevention of knee injury is essential for reducing the risk of development of a Baker cyst for the first time or its recurrence after treatment. Hence supportive footwear appropriate to the activity of an individual is to be worn as well as stoppage of the activity & seeking of medical advice after an injury is needed.
Prognosis- Prognosis of Baker cysts depends on the presence of any underlying knee pathology & the degree of its response to treatment। Most Baker cysts without any underlying knee pathology disappear spontaneously after several years, particularly in children & young adults in whom usually there is no underlying knee pathology। But in some cases a Baker cyst continues to grow with worsening of the symptom & ultimately may rupture & produce acute pain behind the knee & in the calf & swelling of the calf muscles।

In short, a Baker cyst manifests itself as a soft swelling behind the knee with or without pain & can be treated by Ruta, Rhus tox or Bryonia.

But in every case, a doctor should be consulted.

Some aspects of Mumps with homoeopathic mode of treatment

Mumps is an acute, highly infectious disease of childhood caused by mumps virus, a RNA virus belonging to the family of paramyxoviruses which has a predilection for glandular and nervous tissues. The virus is antigenically stable and only one serotype exists. Humans are the only natural hosts. No human carriers or animal reservoirs exist. One attack confers lasting immunity and so second attacks are not seen. Introduction of aggressive immunization has dramatically reduced the incidence of the disease in the developed countries.

Age- Although no age is exempt, it is primarily a disease of childhood and young adults it is uncommon before 2 years of age. It often occurs as epidemics in children of 5-15 years as well as in young people living in groups as in army camps.

Spread of infection- This infection spreads by direct contact, airborne droplets or fomites contaminated with saliva and possibly also with urine.

Source of infection- The source of infection is a patient in the late incubation or early clinical stage of illness. The peak infectivity is about a day or two before the clinical manifestation of parotitis and subsides rapidly thereafter.

Incubation Period- Long and is about 12-25 days, average being 18 days.

Clinical Features- The prodromal symptoms are non-specific and include fever, malaise, headache and anorexia usually followed by severe pain over the parotid gland with its swelling. Sometimes parotid gland swelling may be the first clinical manifestation of the illness. Parotid swelling is unilateral to start with but may become bilateral. There is stiffness of jaw, inability to open the mouth. Dryness of the mouth with foul smell is also present. There is local pain and tenderness over the parotid gland region. There is also tenderness over the posterior ramus of the mandible. The swelling of the soft tissue may proceed downwards. The enlarged parotid glands obscure the angle of the mandible and may elevate the ear lobe. The parotitis is non-suppurative and usually resolves within a week. Rarely only the submandibular gland involvement may occur.

Complications- The most commonest complication is orchitis. It is usually unilateral but may also be bilateral when it may cause sterility due to testicular atrophy. Other less common complications are arthritis, oophoritis, nephritis, pancreatitis, thyroiditis and myocarditis. Besides these, central nervous system involvement is very often seen; it may cause ‘aseptic meningitis’ as well as meningoencephalitis in some cases. But both of these usually resolve without sequelae. A portion of patients with central nervous system involvement involvement may not show any evidence of parotid gland involvement.

Laboratory Investigations- A typical case of mumps does not need any laboratory investigation for confirmation. Laboratory investigations are needed for atypical cases.

(1) Blood Examination- Some non-specific findings may be present in the blood. The WBC may be low with lymphocytes predominating. ESR and CRP may be normal or slightly elevated. Serum amylase levels may be elevated even without pancreatic involvement.

(2) Virus Isolation - Virus can be isolated in cell culture from saliva, throat swab, urine and CSF and virus identification can be performed by neutralization or inhibition of haemadsorption by specific sera.

(3) Serologic test- Positive serologic test for serum mumps IgM antibody or four-fold rise between acute- and convalescent-phase titers in serum mumps IgG antibody level may help in the establishment of the diagnosis of the disease.

(4) Reverse transcription polymerase chain reaction (RT- PCR) Test - Detection of viral RNA by this test is also helpful for confirmation of the diagnosis.

Prophylaxis- Active immunization with a live attenuated mumps virus vaccine given as a single dose can prevent the disease in children over the age of 1 year, below which age the vaccine is not recommended as it may be inhibited by maternally acquired antibodies. The vaccine is not to be given to immunosuppressed individuals or to those with severe febrile illness and also during pregnancy.

Treatment- Homoepathy plays a vital role in the treatment of mumps. Isolation of the patient and proper maintenance of oral hygiene are the first things to be borne in mind. Of the medicines, Bell ( Belladonna) 200 and Rhus.tox (Rhus Toxicodendron) 200 are to be taken alternatively at an interval of three hours between the two medicines three times daily. This should be continued for one week. Then at least for the next two weeks, both the two medicines should be continued two times daily with the gap between them increasing to not less than four hours. If there is associated throat pain, Phytolacca 200 should be added along with four times daily till the pain persists. If temperature is present, Ferrum.Phos 6x should also be given three times daily along with the main medicines.

Labels-Anorexia, Fever, Headache, Immunization, Virus, Ferrum.Phos, Bell ( Belladonna), Reverse transcription polymerase chain reaction (RT- PCR) Test, Attenuated, Isolation, Rhus.tox (Rhus Toxicodendron), Medicine, Swelling, Temperature, Serologic test, IgM, IgG, Acute, Convalescent, Antibody, Arthritis, Oophoritis, Nephritis, Pancreatitis, Thyroiditis, Myocarditis.

IN SHORT-Mumps is an acute, highly infectious viral disease of childhood which begins with non-specific symptoms like fever, malaise, headache & anorexia and is soon followed by severe pain over the parotid gland with its swelling. The parotitis is non-suppurative and usually resolves within a week. The disease may be associated with several complications the most important of which is orchitis. Prevention is done with active immunization with a live attenuated mumps virus vaccine. Treatment is as mentioned above.

But in every case a doctor should be consulted।