Patient details :-
- Patient name – XYZ
- Age – 59 yrs
- Sex – female
- Occupation – house wife
- Problem Since 12 Yrs
Chief complains :-
- Pain in both knee joints
- Mild pain in both ankle joints
- Swelling and stiffness in both knee joints
- Feeling numbness (wooden leg feeling) in right lower limb while sleeping
- Pain in low back radiating to lower limbs on & off
History of present illness :-
- Patient is a known case of GRIDHRASI treated with physiotherapy and traction few yrs back.
- Occasionally feels the symptoms of back ache radiating to lower limbs.
- Patient approached Ayurvedic department for the complaints of swelling and pain in knees, painful and restricted movements of knee joint.
- The complaints were seen since 12 yrs and slowly increasing in nature.
- Presently patient finds difficulty in walking and attending routine activities due to varus deformity.
- She often used to take pain killers which gave only temporary relief.
- She is also c/o feeling of heaviness and pain in her thigh more in the right thigh.
- Patient is unable to turn position in her sleep at night and when both knees touch each other feels severe pain due to which notices sleep disturbance.
- Patient feels slight reduction of pain at rest and aggravation after her activities and late evening hours.
- Patient had approached orthopedician before visiting our department and was advised knee replacement therapy for which patient approached our dept. for a alternative treatment approach.
- All her complaints were seen after attaining her menopause.
Patient had an infected abscess in the left thigh for which she was operated around 12 yrs back. ( Details of which are not available.)
No h/o allergy present.
Patient is a known case of hypothyroidism since 5 yrs and on Tab. ELTROXIN 100mcg 1-0-0
Attained menopause about 12 yrs back
- Menarche – at 15 yrs
- Menopause – at 46 yrs
- Two children ( 1-♀& 1-♂)
- Both deliveries were normal.
Her mother and sisters are suffering from Sandhivata.
Personal history :-
- Diet – mixed
- Appetite – good
- Bowel – regular
- Micturition – regular
- Sleep – disturbed
- Habits – Nil
General examinations :-
- Built – average
- Nutrition – good
- Gait – waddling gait
- Pallor , Icterus , Clubbing – absent
- Lymphadenopathy – absent
- Temperature – afebrile
- Pulse rate – 76/min , regular
- Blood pressure – 140/80 mmHg
- Weight – 72.3 kg
- Tongue – moderately coated
Systemic examination :-
- Respiratory system – No added sound heard.
- Cardiovascular system –S1 S2 heard.
- GIT – NAD
- CNS – No sensory and motor deficit.
- Loco motor system:-
- Inspection –Structural deformity – bow leg deformity seen.
- Palpation –tenderness on both thighs , more in right thigh & particularly medial aspect of thigh.
- Knee joint examination :-
Right Left Inspection Swelling ++ + Redness – – Palpation Tenderness ++( inferiomedial & inferiolateral aspect ) + (inferiomedial aspect) Crepitus ++ ++ Local rise in temperature – – Movements Restricted (flexion) Restricted (flexion)
- Ankle joint examination :-
Right Left Inspection Swelling + + Redness – – Palpation Tenderness – – Local rise in temperature – – Movements Slight painful (dorsiflexion & extension ) Slight painful (dorsiflexion & extension )
- Spine examination –Inspection – no abnormal curvature seen.Palpation – no local rise in temperature.no tenderness
SLR test – (+) in right leg ( around 60 %)(-) in left leg
Ayurvedic assessment :-
- Prakratitah –
- Prakathi – vata pittaja
- Saara – madhyama
- Samhana – madhyama
- Pramanataha – height -5’3”
weight – 72.3 kg
(BMI – 29)
- Saatmya – madhyama
- Satva – madhyama
- Aahaara sakhti – madhyama
- Vyayama shakti – madhyama to avara
- Vaya – madhyama
- Desha – anoopa
2. Vikratitah –
- Naadi – vata pitaaja
- Mootra – not examined
- Mala – not examined
- Jiwha – alpa uplepa yukta
- Shabda – prakrit
- Sparsha –prakrit
- Druk – prakrit
- Aakriti –madhyama
- Dosha –vata kaphaja
- Doosya – rasa, mamsa , asthi
- Agni – sama
- Kostha –madhyama
IIIrd grade OA
Differential diagnosis :-
- Krostuka sheersha
|Shotha||Vata purna drati sparsha(+ in jaanu sandhi)||In all affected joints||With kandu||Krostuka (jackal) sheersha vat|
|Shoola||At prasaran akunchana (+)||Vrishchik dansa vata vedana at all time||With redness||Maharuja|
|Sthana||Sandhi (+)||Hasta ,pada ,shira, gulfa , tvaka, janu , uru,sandhi||Starts from padayo mulam||Janu sandhi|
|Jadya||–||+(+ in thigh)||–||–|
TREATMENT Administered –
- Jeerak choorna ½ tsp-0- ½ tsp with 50 ml water for 3 days.
- Nadi sveda – 27/04/12 to 28/04/12 – no internal medicine was given during this procedure.
- Eranda tail upanaha sveda 30/04/12 to 15/05/12 – no internal medicine was given
- Tab. Ayuginee 1-0-1 for 4 months.
- Yastimadhu shaadita ksheerabasti 24/09/12 to 01/10/12 – no internal medicine was given
Effect of treatment :-
|Symptoms||Right knee||Left knee|
|Before treatment||After treatment||Before treatment||After treatment|
|Akunchana prasaran janya vedana||+4||+1||+4||0|
- Around 60% relief.
- Patient is feeling very much better.
- Knee joint is much relaxed.
- Able to flex her knee.
- Able to walk without much limping.
- Feeling of wooden leg is no more there, according to patient now she can feel her leg.
Kellgren – lawrence grading system for OA-
|I||Doubtful narrowing of joint space & possible osteophytes.|
|II||Small osteophytes, possible narrowing of the joint|
|III||Multiple , moderately sized osteophytes , definite joint space narrowing , some sclerotic areas ,possible deformation of bone ends|
|IV||Multiple large osteophytes severe joint space narrowing , marked sclerosis and definite bony end deformity|