INTRODUCTION

The Almighty gave us legs to walk on gave us mobility; to carry us from place to place and gave us hands to be creative, to perform the daily chores of life and to carry the burden of mankind.

Primitive hunting man used to walk miles to hunt food for himself and his family. He had to have strong legs to do this day in and day out. Since there was never any certainty where he would go and what he would find, his limbs were tuned to work that extra mile or two if the need arose. In those days, limbs or rather the joints served man faithfully for really long number of years and most mortals were mobile till death.

But then came the Industrial Evolution and Man had to develop different faculties. The joints were used less and less till life became

almost sedentary :

From Home elevator car Office elevator.

The only exercise people indulged in is climbing walls and jumping to conclusions! The joints now had to be prescribed exercise

by doctors, as a must for maintaining mobility and good health.

As a result of disuse – joints stiffened, synovial fluid dried up, joints started degenerating earlier. Every which way you looked at it, the joint refused to cooperate. What more can you call spondylitis in

early 30s and sever OA knee in mid 40s?

JOINTSDefinition :

It is a junction between two o more bones or cartilage.

It is a device to permit movements.There are more joints in the child than

in an adult.

Classification of Classification of JointsJointsFunctional

1) Synapthrosis - Immovable It. 2) Amphiarthosis- Slights movable 3) Diarthrosis - Freely movable

Structural Classification 1. Fibrous Joint2,Cartilaginous Joints * Synchonorosis or Hyaline Cartilage Joints.

It B/w Epiphysis and diphysis of a growing long bone. Example :

Spheno – Occipital Bone.Costochondral and Coststernal Joint.

* Symphysis or fibro cartilaginous Joints.

Example: Symphysis pubis Manabrio sternal joint

3. Synovial Joints or Diarthrodial Joints

• Also k/s Freely movable joints

• The ends of tow bones are held together by joint capsule, with ligaments and tendons inserted at the outer surface of capsule.

• A synovial joint has a fluid filled cavity. The fluid is known as synovial fluid (produced)

• Synovial fluid acts as lubricant.

• Most of the disease of Joints affected Diarthrodial or Synovial Joints.

Types of Synovial Joints & Types of Synovial Joints & their movementstheir movements

1 .Plane or Gliding movement

•Example- Intercarnel Joints • Inter tarsal joints Joints b/w bertebras •Movements – Gliding movements.

Hinge Joints•Uniaxial Joints•Movements are limited in one plane. Example - elbow joint

Ankle joint Interphalangeal joints

•movements - Flexion & extension

Pivoto Joints•Uniaxial Joints•Example - superior and inferior radio ulnar. Median Atlanto axial joints

•Movement - Rotation onlyCondoyle Joints• Joints permit movements mainly in one plane around transverse axial but partly in another plane around vertical axis.• Movement possible – Flexion & extension & limited rotation.• Example - Knee joint

right & left Saw joints 260

Ellipsoid Joints•Biaxial Joints•Free movement are permitted around both the axis.•Movements Possible –Flexion, Extension abduction, adduction and circumduction.•Example - wrist Joints Metacarpophalengeal joints.

Saddle Joint (Seller)•Multiaxial Joints•Move possible-- Flexion, Extension, adduction, abduction and conduct rotation.•Example Sternoclavicular joint Calcaneocuboid joint

Ball and socket Joint (Spherodial)

•Multiaxial joint•Movements occurs around and indefinite number of axes which have common centre.•Movements-Flexion, extension, abduction, adduction, medial rotation, Lateral rotation and circumduction.•Example - Shoulder joint Hip joint Talocalcaneonavicular joint

Factor maintaining stability of joint • Muscles

• Ligaments

• Bones

Aging & Joints• With aging, a decrease in synovial fluid, thinning articular cartilage and

decrease flexibility ligament occur.

• Most individual experience some degeneration is the knees, elbows, hips

and shoulder due to aging presses.

ARTHRITIS• It is a form of Rheumatism in which joints have become inflamed and painful• Characterized by Inflammation, Pain and stiffness and moving usability• Arthritis affects about 10 % people of world Population.• Most common in older Aged people due thinking of particular cartilage and decrease in synovial fluid

Also due to injury, Truma, Allergy and infections disease spread such as

•Tuberculosis.•Gonococcal

•Syphilitic etc.

Important cause of ArthritisImportant cause of Arthritis1. Diffused connection tissue disease such as RA

2. Degenerative joint disease such as OA.

3.Metabolic and endocrine Disease such as Gouty Arthritis.

CLINICAL MANIFESTATION

(1) Arthralgia- Pains in Joint

(2) Chondritis - Inflammation of Cartilage

(3 Synovitis - Inflation of a Synovial membrane.

in joint.

CLASIFICATION OF

ARTHRITIS

1. Rheumatoid Arthritis – and its variants such as Arthritis with psoriasis Juvenile rheumatoid arthritisRheumatic spondylitisReiter’s syndrome

2. Arthritis due to rheumatic fever.

3. Osteoarthritis.

4.Arthritis associated with known infectious agents – e.g.

Gonococcal,

Tuberculoses – most common Involve – spine, hip join &

Knee jointsTuberculosis of spine is

termed as POTTS DISEASE

Spondylitis.Syphilitic –

Pneumococcal, etc.

5.Associated with metabolic or bio-chemical or endocrine abnormalities - Gout, hemoglobinopathies, onchronosis, acromegaly, etc.

6.Traumatic arthritis

7.Neuropathic arthritis

8.Allergy and drug reaction.

9. Arthritis with blood disorders

10. Connective tissue disease –

S.L.E.

Polyarhteritis nodosa,

Dermatomyositis.

11. Miscellaneous Disorders -

Amyloidosis

Erythema multiform,

Ulcerative colitis,

Sarcoidosis

OSTEOARTHRITIS (O.A) Also called as

Osteorthrosis or Degenerative Joint DiseaseResult from a combination of aging, irritation of joints, wear and abrasion.• Commonly known as wear and tear arthritis and leading cause of disability in older individuals.• Most common form of chronic disorder of synovial joints particulars weight bearing joint

It is characterized by : Degeneration of the cartilage with associated over growth of bone at the margin of joints And Changes in synovial membrane

Affect up to 10% of world population

In Older Age. The Articular cartilage show Degenerative changes in CENTRE (Fibrillation of cartilage) AndProliferative change around the edges (Osteophytes )

IT IT COMMONLY COMMONLY INVOLVES :INVOLVES :

•The distal IP joints of the fingers- to form bony swelling – The Heber den nodes.

• The proximal Interphalangeal finger joints – to form bony swelling – The Bouchard nodes

The lumbar spine – lumbar spondylitis

•The cervical spine – cervical spondylitis.

•The large joints –

including Hips and Knees.

PRIIMARY– OESTEOARTHRITIES

•Occur more commonly in women than men .

•Progress begin by end of 4th decade.

Pathogenesis-Wear and tear with repeated minor trauma, heredity AND obesity.

Secondary Osteoarthritis

-May appear at any age.-Results from any previous injury, fracture inflammation and congenital dislocation of

the hip.

Clinical manifestaslation :

Joint stiffness. Diminished mobility, pair etc.

The symptom are prominent on walking up

from the Bed in morning..

The degenerative changes in the

interphalenges joints

lead to hard bony and pain less modules

at the base of terminal.

Its phalanx called as HEBERDEN”S NODES.

HEBERDEN”S NODES

Pathos Physiology of secondary osteoarthritis

Most marked in weight – bearing region. Initially

Loss of cartilaginous matrix Resulting

Progressive loss of normal metachron

Focal loss of chondrocytes Causes

Loosening, flaking and fissuring of Articular cartilage. Resulting

Breaking off of pieces of cartilage.

Developing of Osteophytes.

Thicking of jointCauses swelling.

MACHINICAL SYMPTOMS ARE CHARACTERRIZED

BY:

Pain: The pain is usually relieved by rest. Night pain may be a feature. Pain on weight- bearing, if the lower limb joints are involved.

Stiffness after rest: usually lasting less than 5 minutes – with the patient loosening up quickly by moving the joints. Morning stiffness is not a prominent feature and short lived if present at all.

Swelling is usually bony rather than soft tissue in character.

Risk factors:•Age

•Obesity

• Repetitive stress injury / trauma to joints.

•Sex – Female are more frequently involved (10:1)

•Genetics – this is a problem often seen within families.

•Other diseases causing cartilage damage – resulting in secondary osteoarthritis.

X RAY OF NORMAL KNEE JOINT

X RAY OF OSTEORITHRITIC KNEE

OSTEOARTHRITIS OF KNEE

Most commonly affected joints found in clinical practice. Joint space narrowing with Osteophytes (new bone formation) and loose bodies are seen. The patellofemoral articulation is the most commonly affected with medical tibiofemoral compartment being second. In early disease, spiking of the tibial tubercles and marginal Osteophytes are seen.

OSTEORTHITIS OF THE HIP JOINT

This is the second most affected joint in the body. Secondary osteoarthritis following: Congenital dysplasia. PERTH’S DISEASE congenital dislocation, slipped epiphysis, Aseptic necrosis etc is more common than primary osteoarthritis.

Joint space reduction and marginal osieophyisis are seen. The femoral head migrates either superiorly or medially. A-P views of the hip usually provide adequate information. In certain cases, a CT scan show areas of subaiticular crescents as in aseptic necrosis or geode formation in advanced cases.

NORMAL X RAY OF THE HIP JOINT

OSTEORTHITIS OF THE HIP JOINT

OSTEOARTHRITIS OF THE HANDS

In osteoarthritis, the distal interphalageal joints are most commonly affected with joint space narrowing and large peripheral osteophytes resulting in the clinically evident

“Heber dens nodes “

X RAY OF ARTHITIS OF THE TOE JOINT

RHEUMATOID ARTHRITISDefinition –

A systemic connective tissue disorder which affects predominantly

the synovial joints, hence the term rheumatoid disease.

Its systemic manifestation includehematological,

pulmonary, neurological & CVS abnormalities

Etiology :1. Age – any age, majority Between 20-40.2. Sex – more in females than males = 5:1 3. Climate – in temperature climate.4. Familial tendency.5. Genetic factors.6. Sex hormones – more in female than in males. 7.Psychological factor – Physical 8.Exposure to cold & wet.9.Trauma:

Arthritis may start in a joint which has been the seat of trauma and other joints subsequent get

involved.10.Environmental triggers.

EITIOPATHOGENISIS OF REHEVMATOID

ARTHERITIS

(I)IMMUNOLOGIC FACTORS

(II) GENETIC FACTOR

Genetic susceptibility

( MHC – Class – II ) Antigenic stimulation ( By infections agent )

CD4 + T –Cells

Cytokines ( TNF – α, INF – γ, IL -1)

Activate Activate ActivateB – Cells Endothelial Cell Macrophages

Anti IgG – antibody Release of adhesion Cytokines(Rheumatoid factor) molecule Protease

Formation of immune complex, Inflammatory Cells,

Inflammatory damage to synovium, small vessel collagen

Destruction of cartilage bone fibrosis, ankylosi

joint Deformities

Types of Presentation:-1.Classical –

Pain, stiffness and swelling of small joints of head, wrists.2.Palindromic –

Pain, swelling and redness usually of a single joint, followed by rapid return to normal after several days.3. Systemic -

Weight loss, Pleurisy and pericarditis but minimal joint involvement.4. Polycyclic -

Plain and stiffness in shoulders and hips with subsequent synoptic.5. Monoarthritic -

Single joint involvement usually the knee.6. Acute Onset -

Sudden overnight onset with stiffness and pain.7. With generalized lymphadenopthy.

Clinical Features :-In early stage –

• Joints are warm, swollen and tender.

• Weakening of joints, capsule and tendon along with ligament damage.

• Instability, subluxation, dislocation.

• Severe joint damage may lead to fibrous or body ankylosis

1.Hands -

Tenosynovitis (inability to appose the palms) Rupture of flexor/ extensor tendons with weakness of grip.

2.Legs - Knees – synovial effusion Ankles – Valgus deformity

3.Cervical Spin -

secondary degenerative changes.

1.Skin - Palmer erythematicRashes Psoriasis.

2.Myositis - Muscle wasting around inflamed joints3.Bone - Generalized osteoporosis4.Eye - Keratoconjunctivitis scleritis5.Heart - Pericarditis

MyocarditisRheumatoid Vulvulitis.

6.Blood - Anemia (mild normocytic norm chromic anemia)

G.I. bleeding by Aspirin and other Analgesics.7.Respiratory- Pleurisy and ale Ural effusion

Rheumatoid nodulesPulmonary hypertension

8.Nervous System - Neuropathy Nerve root compression Pain

Numbness or Paraesthesiae9.Kidney - Proteinuria

Microscopic heaematuria10.Investigation - E.S.R. (elevated)

R.A. Factor S.L.E.

11.Radiology - Reduced of joint space X-ray bone Deformity

X-RAY & bone Deformity

GOUTY ARTHRITIS

In Gouty Arthritis, sodium create crystals are deposited in the soft tissue of the joints.

The crystal irritate and erode the cartilage causing The person who suffers from govt. either produce excessive

uric acid or is unable to excrete as much as normal.Result in building up uric acids in the blood.

Uric acid + sodium ↓

Crystal of Sod. Ureate ↓

Deposited in the soft tissue of the joints.

DIAGNOSIS OF ARTHRITIS

1.PHYSICAL EXAMINATIONWhenever a patient presents with a problem joint, the primary care physician has to picture All the structures that makes up a joint. Any one or more of the following may be involved: • Trauma • Degenerative changes• Infection: both acute and chronic and• Neoplastic

•If a Patient is looking with pain in joint the pain can be of three things.

Bone Muscle Nerve

•Examination of – Swelling /Edema•Tender•Redness•Any eruption•Tortuousness of veins•Hot/cold ( temperature )•Movement•Sound (cracking )

To complete the list, metabolic (gout) & Neoplastic causes also have to be kept in mind.

On the other hand the joint may be affected as part of a widespread systemic disease –

Rheumatoid arthritis and other seronegative spondyloarthropathies.

When a patient presents with any joint pain, it is the duty of the physician to assess the entire

locomotors system:

ESTABLISH THE EXTENT OF ABILITY OR

DISABILITY To carry out routine, day-to-day chores.

Eg in rheumatoid arthritis can he open / shut a zip or unbutton her blouse; what are the activities which are not possible now and

should be our first target at improvement. Ask the patient:

•Can you climb stairs?•Can you dress normally?•Are you free from any muscle stiffness any where in the body? If the answer is No. go into details an if the answer is yes, it is unlikely that the patient has any significant involvement in affection of a joint / muscle group.

OBSERVATIONAsk the patient to disrobe as much as is comfortable for both the physician and the patient. Ideally patient should be in undergarments. Stand away from the patient and observe closely as the patient carries out your instructions.Observe the patient from behind to

Assess the buttocks, shoulder, Para spinal muscles. Are they symmetrical? Is there any deformity or swelling? Is the spine straight or tilted/ curved to one side?

Observe from sideAre cervical and lumber curvatures normal?

Ask the patient to touch the toes.Is the flexion of hip and spine normal? (ie whether he can touch the toes)

From the front 1. TOUCH head both ways – checks lateral flexion of the neck.

2. Open and close the mouth – Temporo-mandibular joint.

3. Ask to put hands behind the head – tests gleno-humeral and sterno clavicular movements.

4. Ask to hold arms straight – tests elbow extension.

5. Ask to supinate and pronate the hands.

6.Ask to spread the fingers and show you the hands-look for any wasting, deformity or swelling (s).

7.Ask to put thumb and index finger together – checks pincergrip

1.Closely observe the lags – quadriceps bulk, any deformity or swelling.

2.Knee joint- any effusions by patellar tap?

3.Observe feel – any deformity? Any callosities?

4.Ask to walk around- is the gait normal? Are the amis swinging while walking?

5.Is the strike of heal on the ground as well as lift of toes from the ground normal?

6.Can he turn quickly and normally?

LAB . INVESTIGATION OF

ARTHRITIS

• BLOOD INUESTIGATION ESR RA- FACTOR ASOTITER SLE

X-RAY REPORTS OF ARTHRITIES

•C. T. SCAN

•MRI

•SYNONICAL BIOPSY

•URIN TEST

OTHER MODE OF TAEATMENT•ALLOPATHY

Anti inflammatory Pain killer Relexacent Sedatives Local application Hot fomentation

•AYUERVEDIC •UNANI•NATUROPATHY

•YOGA

Homeopathic Mode of Treatment

• Examination : Physical and LAB Investigation

• Case taking• Constitution• History : weather patient had any

trauma or accident in the past• Miasm : psora , syphilis or sycosis• Diathesis : Rheumatic or Gouty • Mental • Location : Hand , Wrist , Knee,

Cervical spine or Hip joint• Ailments (Cautions)

HOMEOPHATHIC REMADY

FOR

ARTHRITIS, RHEUMATISM & GOUT

           ABROTANUM Especially for ANKLE JOINT & WRIST JOINT For OSTEOARTHRITIS Rheumatism: •    For excessive pain before the swelling comens   • From suddenly –checked Diarrhea or other Secretion, Alternate with Hemorrhoids, with dysentery Aggravation; - at night and from cold Amelioration; - by motion

ACTAEA SPICATASpecial Affinity for Smaller joints

 

Wrist, & Fingers Ankles & toes Rheumatism:·  Swelling & aching in joints after a slight exercise.·  Affected joints are swollen and in affected limbs great weakness.·  Right arm and right wrist are specially affected. Pain: Are violent tearing and drawing character Aggravation: - At night motion and change of weather.

3)ARNICA MONTANAEspecially for Traumatic Rheumatism or Arthritis.

Rheumatism:        Ascending type of rheumatism.        Patient cannot bear pain         Great fear of being touched or struck. Pain; in the back and limbs as if bruised or beaten. cannot walk erect on account of pain in pelvic organ. Aggravation: At rest; when lying down: from wine

Amelioration: From contact ; Motion

BENGOIC ACID Especially for GOUTY ARTHRITIS In a person who have History of Suppressed Gonorrhea, Syphilis. Gouty concretion arthritis Affects all the joints, especially knee joint Cracking on motion; Nodositis Urine dark brown And The urinous odor highly intensified

Pain – tearing, stitching , in large joints, Pain aggravates in night

 BRYONIA ALBA For Articular Rheumatism

Allumina is chronic of bryonia Great dryness of all mucus membrane. Great thirst for large quantity of cold water at long intervalPain: Stitching, tearing, worse at night.Aggravation: from slight motion, exertion, touch, Suppressed discharges of any kind, at 9 pmAmelioration: Complete rest, lying on painful side pressure, cold.

CALCAREA CARB For Gouty Nodos ties about fingers Arthritis nodosa deformans. Aggravation: cold air wet weather, cold water in morning. Amelioration: Lying on painful side. 

CAULLOPHYLLUMFor Arthritis Deformam in women’s.Affinity for smaller joints.

Pain: Severe drawing, tearing pain. Pain is of flying nature; migrate from one place to another. Pain in fingers and wrist. Fingers are very stiff. Aggravation: in open air and coffee Amelioration: By emission of flatus.

 

CAUSTICUMFor Rheumatoid ArthritisFor Chronic Articular Rheumatism

Rheumatism: Of joints with stiffness and contraction of flexor tendons, Shortening of muscles. Aggravation: in clear weather Amelioration: In damp weather and by warm air.

CMICIFUGA (Actaea recemosa)Articular rheumatism of lower limb.Joints commonly affected are lumbo-sacral region

and Big Joints. Rheumatism:·        Good remedies for muscular rheumatism.·        Especially affects the bellies of muscles of neck and back.·        Joints commonly affected are those of LUMBO-SACRAL REGION and big joints.·        Uneasiness, restlessness, aching in the limb with pain in lumbar and sacral region.·        Rheumatism alternates with mental symptoms. Aggravation: ·        from using arm in sewing , type writing, piano-playing.·        From cold damp weather and during menses. More severe the flow, greater the sufferings. Amelioration: from warmth

COLCHICUM AUTUMNALEValvular Disease or pericrditis following rheumatism.Acute Rheumatic fever.Action more marked on Small Joints

Rheumatic pain Of the clavicle, neck, shoulder, arms and back.·        In the elbow joint, forearm, waist, and ligaments of the finger Joints, and of great toes.·        With lameness in the arm which make it impossible for the patient to hold lightest thing.·        Flying pain in the Hips,·        Tearing pain in thighs and knee joints with swelling.·        Tingling pain in Toes.·        Pain has tendency to move from one joint to another ; from one side to other , from below to upwards or from above to downwards. Aggravation : From cold damp weather, by motion, during Autumn Amelioration: from warmth, by rest, and lying down.

FERRUM MET ELLICUM For Neuralgic and Rheumatic Pain. Rheumatism of LEFT SHOULDER·      Tearing and stinging nature of pain.·       Rhematic Pain in Deltoid muscle.·        Violent pain in muscles and along the nerves. Aggravation: From cold and rest

Amelioration: slowly moving

KALI BICHROME Rheumatism·     For Syphilitic Arthritis·     Tearing sensation in the tibia, with swelling and stiffness of joints.

·     Rheumatism alternates with gastric symptoms. Pain·      In small spots, which can be covered with TIP of finger.·      WONDERING PAIN, Aggravation: from cold and motion.

KALMIA LATIFOLIAFor Acute Rheumatic fever.

Rheumatism:-·   Caused by chill, exposure to cold·   Right-sided affection.·   Sensation of numbness, coldness, weakness, in the limbs. Pain: WANDERING PAIN, changes place suddenly, goes from one joint to other. Pains are sticking darting, pressing, shooting in the a downward direction. Joints are hot, red, painful and swollen.Þ   Heart complaint alternate with Rheumatism. Aggravation: from least movement , becoming cold. Amelioration: continued motion

LACHESIS For Rheumatic Carditis. Sciatica, right side, better on lying down. Pain In lower Extremities, in Tibia, in Neck worse cervical region Shortening of tendons. Neuralgia of coccyx, worse rising from sitting posture. Sensation of threads stretched from back to arms, legs, eyes, etc. Aggravation: from warm bath, pressure or constriction, hot drinks Amelioration: appearances of discharges warm application

LYCOPODIUM CLAVATUMChronic Articular ArthritisRight-sided remedy

Rheumatic Pain In ankle, and finger Joints, Painful Callosilitis (CORNS ) on soles All disease is worse in the afternoon from 4 to 8 pm. Tearing in shoulder and elbow joints. One feet hot and other is cold. Chronic gout, with chalky deposit in joints. Aggravation: Right side, from right to left, from above downward. 4am to 8 pm. from heat Amelioration: by motion. After mid night

NATRUM MUR Chronic articular Arthritis.

Based on History of Dyscrasia. Symptoms are worse from sunrise to sunset, especially from 10 to 11 pm. Painful contraction of the Hamstring. Pain in back with desire to support. Palms hot and perspiring. Ankles weak and turn easily. Cracking in joints on motion. Aggravation: from noise, music, lying down, heat, and talking. Amelioration: open air, pressure against back. Lying on right side.

RHODODENDRON Fibrous deposit is great Toe-joint. Right-sided remedy. Chronic Osteoarthritis Gout with fibrous deposit in great toe joint. Rheumatism:-

Chromic Rheumatism affecting the smaller joint Acute inflammatory swelling of the joints. Pain.·       Drawing ,tearing pain in the limbs.·       Sometimes wandering from one joint to other.·       Pain in dorsal region, extending to arm, in bone and periosteum·       Pain in the shoulder that arm cannot be moved. Aggravation ; During rest, before and during storm Amelioration; By warmth, wrapping up moving.

RHUS- TOXICODENDRON Right-sided remedy For Osteoarthritis

Traumatic and Articular Arthritis. Rheumatism:-·     Caused by lying on damp ground, summer bathing, working in damp place.·     Great restlessness, anxiety and apprehension.·     Always want to be moved, cannot remain in one place. Pain.:·       As if Sprained, As if muscle or tendon were torn from its attachment.·       As if bone were scrapped with knife. Aggravation; - After midnight, in rainy weather, " On first moving, and getting up in morning." Amelioration; - By walking, and continued motion.

SULPHUR Facilitates absorption of serous or inflammatory exudates in pleura & joints

Acute and Chronic RheumatismAfter the attack of acute Dyscrasia

Aggravation; By standing, rest, heat, bathing, changeable weather. Amelioration; By dry warm weather, lying on right side

THUJA OCCIDENTALISGonorrheal ArthritisSycotic Poison, Arthritis deformens

Aggravation; At night, at 3pm and 3 am, form cold damp air . Etc… Amelioration; In open air, by movements, pressure, rubbing

MANAGEMENTThe concept of joint protection is

vital for the patients with OA. Especially where large joints are involved.•Protection from overuse is important.

•Assistant devices to reduce weight bearing joint pain – ie canes.

•Reduce impact exercise like jogging. Increase non weight bearing exercise – ie swimming / cycling..

•Good quality footwear, when walking recreationally.

•If any leg length discrepancy, ensure it is corrected.

•Weight reduction is crucial especially in obese patients

with large joint problems on weight bearing.

•Physiotherapy will maintain joint protection through

optimizing the strength of adjacent supportive

muscles.

•Heat and ultrasound may relieve muscle spasm.a

General Measures1.Diet One has to avoid the following items. Tea, Coffee, Fried things, Salt,

Chilly, Spices and condiments milk and milk products. Heavy digestive Dal , Rice , Pickles Alcohol an d Non- veg diet .

2. Yogic therapy include Yogasanas, Pranayama, rest and

other arthritic exercise3.Rest - Both mental and physical4.Exercise- morning walk, running etc.5. Correction of Anemia 6. Avoidance of cold, dampness and draughts. 7. Removal of focal infection

3.Exercises for arthritis

CORRECT YOUR POSTURES

1.Correct postures of sitting, standing and walking make a

difference in patients of cervical spondylitis. Wrong postures, even temporary, can result in strains on

the joints and bring diseases. There should not be any hump in the back when the child learns to sit, stand and walk

3.When we sit, stand, walk or drive a vehicle, do not bend spine Car drivers not keeping their backs straight also get neck pains. The seat of the car should be adjusted nearer to the steering wheel and if there is space between seat back and upper hips area.

A small pillow should be placed in between.

Sleep, bed and pillow: Both neck and back pain have a definite bearing with the type of bed

7. Sleeping posture. Those who suffer from cervical spondylosis should try to sleep on the left or right side instead of continuous sleeping on the back. While sleeping on the sides of the body, one should lie with the legs slightly flexed or bent at the knees towards the abdomen. This offers great relaxation to

the muscles

Standing postures during parties: In most of the parities, the fashion is to stand for a long lime at one place.

13. Working on computers need more care for neck pain. The table should match your height. Roughly your elbows and table top should be at same level. Your eye level should be in alignment with screen of computer continuously for hours

Case:-Case:-

Patient’s Name:-Patient’s Name:- Mr. Bhagwan Lal PatelMr. Bhagwan Lal Patel

Address:-Address:- Arnodh (Dist.:-Indore)Arnodh (Dist.:-Indore)

Age:-Age:- 68yrs.68yrs.

Occupation:-Occupation:- FarmarFarmar

Date:-Date:- 14/11/0814/11/08

Mobile:-Mobile:- 9900924506299009245062

PRESENT COMPLANTSPRESENT COMPLANTS

Pain & Swelling in both Knee & Ankle Joints Pain & Swelling in both Knee & Ankle Joints (Since:- 4 Months)(Since:- 4 Months)

Allergic Rashes on Neck & Face taking Allergic Rashes on Neck & Face taking antiallergic.antiallergic.

Difficulty in Breathing.Difficulty in Breathing.

Pain worse when goes to upstairs & down Pain worse when goes to upstairs & down stairs.stairs.

Personal history Personal history

Thermal Relation:- chilly Pt.Thermal Relation:- chilly Pt.

Thirst:- 10 to 12 glass per day.Thirst:- 10 to 12 glass per day.

Appetite:- decreased.Appetite:- decreased.

Aggravation:- when goes upstairs, down Aggravation:- when goes upstairs, down stairs & cold wet weather.stairs & cold wet weather.

Amelioration:- warm application.Amelioration:- warm application.

Stool:- ClearStool:- Clear

Urine:- ScantyUrine:- Scanty

MENTAL GENERALMENTAL GENERAL

Restlessness.Restlessness.

FearfulFearful

IrritableIrritable++

General ExaminationGeneral Examination

Built:- NBuilt:- N

Skin:- Rashes on Neck & FaceSkin:- Rashes on Neck & Face

Toung:- Red & CrackedToung:- Red & Cracked

B.P. 130/80 mm/hgB.P. 130/80 mm/hg

11STST Prescreption Prescreption

RxRx

Rhus. Tox. 200] 1 drmRhus. Tox. 200] 1 drm

T.D.S. for 7daysT.D.S. for 7days

Second prescriptionSecond prescription

C/oC/o

Slightly relief in pain & swellingSlightly relief in pain & swelling

Rashes disappearsRashes disappears

RxRx

Plc 200]1/2 dmPlc 200]1/2 dm

B.D. for 7 daysB.D. for 7 days

C/oC/o

Pain & swelling as it is.Pain & swelling as it is.

Sneezing & coryza.Sneezing & coryza.

RxRx

Rhus. Tox. 200]1/2 dmRhus. Tox. 200]1/2 dm

B.D. for 5 daysB.D. for 5 days

C/oC/o

Pain & Swelling worse.Pain & Swelling worse.

relieved in coryza & relieved in coryza & sneezing.sneezing.

Stiffness in neck.Stiffness in neck.

Pain in both shoulder Pain in both shoulder

Rx Rx

Rhododendron 200 ]1/2 drmRhododendron 200 ]1/2 drm

T.D.S. for 3 daysT.D.S. for 3 days

Plc 200 ] B.D for 5 daysPlc 200 ] B.D for 5 days

AdviseAdvise

Avoid sour things, fatty food & high rich Avoid sour things, fatty food & high rich protein diet.protein diet.

Do some mild exercise Do some mild exercise

C/oC/o

Much relief in all complaintsMuch relief in all complaints

mentally feel wellmentally feel well

Rx Rx

Plc 200 ] 1 drmPlc 200 ] 1 drm

B.D for 8 daysB.D for 8 days

C/oC/o

No further reliefNo further relief

Complaints are as it isComplaints are as it is

RxRx

1.1. Medorrhinum 1M ] 1doseMedorrhinum 1M ] 1dose

2.2. Rhus tox 200 ] 1drmRhus tox 200 ] 1drm

B.D. for 7 daysB.D. for 7 days