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 “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 “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.