E-ISSN:2456-3110

Case Report

De quervain’s tenosynovitis

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 7 August
Publisherwww.maharshicharaka.in

Agnikarma with Kshoudra for pain management in De Quervain’s Tenosynovitis - A Single Case Study

Anju D.1*, Muralidhara N.2, Sweta K.3, Surendranath D.4
DOI:

1* DR Anju, Post Graduate Scholar, Department of PG Studies in Shalya Tantra, Sri Sri College of Ayurvedic Science and Research Hospital, Bengaluru, Karnataka, India.

2 N Muralidhara, Professor, Department of PG Studies in Shalya Tantra, Sri Sri College of Ayurvedic Science and Research Hospital, Bengaluru, Karnataka, India.

3 KM Sweta, HOD and Professor, Department of PG Studies in Shalya Tantra, Sri Sri College of Ayurvedic Science and Research Hospital, Bengaluru, Karnataka, India.

4 Dhyan Surendranath, Associate Professor, Department of PG Studies in Shalya Tantra, Sri Sri College of Ayurvedic Science and Research Hospital, Bengaluru, Karnataka, India.

De Quervain’s disease, also called gamer’s thumb or mother’s thumb, is a common pathological condition of the wrist. It is commonly known as de quervain’s tenosynovitis a repetitive use of wrist and thumb lead to an inflammation of Abductor Pollicis Longus and Extensor Pollicis Brevies tendon and all layers of their associated tendon sheath. The overall incidence of De Quervain’s tenosynovitis is 0.9/1000 person. As per Ayurvedic parameters this condition can be correlated to Snayugata Vikara, which usually presents with Sthambha, Shula, and Kriyavasakthi. According to Ayurveda, Snayugata Vata - Snehana, Upanaha, Agnikarma, and Bandha are treatments advised. Agnikarma with “Kshoudragudasnehacha” is mentioned is Sandhiasthsirasnayugatavikara. Kshoudra is mentioned as Dahanopakarana for Sira-Snayu-Asthi Sandhi because of penetration to deeper structures. Till date splinting, systemic anti-inflammatories and corticosteroid injection are the most frequently utilized non-surgical treatment options and if these processes are ineffective, the tendon sheath of the 1st dorsal compartment is surgically released. This study includes a case study of a gentle man of 34 years who gradually developed pain over base of right thumb and wrist joint since 1 month. Agnikarma with Kshoudra was performed in 4 sittings, with a gap of 7 days and assessment was done with subjective and objective parameters. The therapeutic effects of Agnikarma with Kshoudra resulted in relief of pain and muscle spasm, acceleration of healing, promotion of resolution of inflammation and painless range of movement of joint. Kshoudra Agnikarma is cost effective, easy to perform with better aesthetic outcome.

Keywords: De quervain’s tenosynovitis, Kshoudra, Agnikarma, Pain, Case Report

Corresponding Author How to Cite this Article To Browse
DR Anju, Post Graduate Scholar, Department of PG Studies in Shalya Tantra, Sri Sri College of Ayurvedic Science and Research Hospital, Bengaluru, Karnataka, India.
Email: 		DR Anju, N Muralidhara, KM Sweta, Dhyan Surendranath, Agnikarma with Kshoudra for pain management in De Quervain’s Tenosynovitis - A Single Case Study. J Ayu Int Med Sci. 2022;7(7):159-162.
Available From
https://jaims.in/jaims/article/view/1996

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-06-28 2022-06-30 2022-07-07 2022-07-14 2022-07-21
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 18%

© 2022by DR Anju, N Muralidhara, KM Sweta, Dhyan Surendranathand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Anju D et al: Agnikarma with Kshoudra pain management De Quervain’s Tenosynovitis

Introduction

De-Quervain’s disease, also called gamer’s thumb or mother’s thumb, is a common pathological condition of the wrist. Wrist pain is a very common complaint that can have dramatic changes on the people productivity at work, sporting, artistic pursuits and daily activity of living, nowadays it is more common, especially the people using mobile phonset more than 5 to 6 hours in a day or repetitively use of hand and wrist. It is commonly known as de quervain’s tenosynovitis a repetitive use of wrist and thumb lead to an inflammation of the abductor pollicis longus and extensor pollicis brevies tendon and all the layers of its associated tendon sheath. The overall incidence of De Quervain’s tenosynovitis is 0.9/1000 person. The estimated prevalence of de Quervain’s tenosynovitis is about 0.5% in men and 1.3% in women with peak prevalence among those in their forties and fifties. A thorough history and physical examination and maneuvers including the Finkelstein test, can help differentiate between these causes.[1]

According to Ayurveda, Snayugata Vata - Snehana, Upanaha, Agnikarma, and Bandha are the treatments advised. Agnikarma with “Kshoudra Guda Snehacha” is mentioned in Sandhi Asthi Sira Snayugata Vikara. Kshoudra is mentioned as Dahanopakarana for Sira-Snayu-Asthi Sandhi because of penetration to the deeper structures.[2]

The therapeutic effects of Agnikarma with Kshoudra includes relief of pain and muscle spasm, acceleration of healing, promotion of resolution of inflammation and increase in the range of movement of joint.[3] Till date splinting, systemic anti-inflammatories and corticosteroid injection are the most frequently utilized non-surgical treatment options and if these processes are ineffective, the tendon sheath of the 1st dorsal compartment is surgically released.[4]

Case Report

A 34-year-old male patient with no significant medical history, presented with chief complaints of pain over base of right wrist and thumb which affected his routine work and job for more than 1 month.

On physical examination, inspection revealed mild swelling, tenderness noted as severe with Grade 8

(VAS) and range of movements was painful on palpation.

Positive Finkelstein’s test on right wrist confirmed the diagnosis of De Quervain’s tenosynovitis.

Materials and Methods

Materials Required

1. Kshoudra

2. Borosil glass pipette

3. Stove

4. Sterile Ladle

5. Mixture of Madhu -Sarpi (Equal quantity)

6. Sterile cotton balls

Duration of study

Duration of treatment - 21 days

Agnikarma sittings were performed on 0th, 7th, 14th and 21st day

Follow up - 28th day & 35th day

Preparation of Kshoudra & procedure for Agnikarma

Poorvakarma

1. Study was done after obtaining an informed consent from the patient.

2. Arrangement of materials

Pradhanakarma

1. Patient is allowed to sit in comfortable position and instructed to extend the elbow with fisted arm

2. The tender points were marked using a pen.

3. Heating of Kshoudra

4. Using a Borosil Pipette Kshoudra was sucked, dropped over the marked site for 1 to 2 seconds.

Paschatkarma

1. Application of Madhu - Sarpi mixture done

Results

Assessment was carried out before and after treatment for Relief of Pain, Range of Movements of right wrist and Special Tests / Diagnostic Tools.


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Anju D et al: Agnikarma with Kshoudra pain management De Quervain’s Tenosynovitis

By the end of the stipulated four sittings of Agnikarma using Kshoudra, it was seen that there was satisfactory improvement in the complaints of pain and range of movement in the subjects. This result was assessed using VAS for Pain and Stiffness with Range of movements reduced from severe to mild. The therapeutic effect of Agnikarma with Kshoudra showed significant results during follow up with no recurrence.

Criteria 1st Sitting 2nd Sitting 3rd Sitting 4th Sitting
Pain 8 6 4 1
Range of Movements Severe Pain Moderate Pain Moderate Pain Mild Pain
Finkelstein Test Positive Positive Positive Negative

Follow Up

Criteria 1st Follow Up 2nd Follow Up
Pain 1 0
Range of Movements Mild Pain Absent
Finkelstein Test Negative Negative

Observation

The final result of the case was observed with no scalds and with better cosmetic outcome.

jaims_1996_01.JPGArrangements of materials
jaims_1996_02.JPGHeating of Kshoudra

jaims_1996_03.JPG0th day - Using pen tender points were marked

jaims_1996_04.JPGDropping of Heated Kshoudra over tender points for 1-2 sec

jaims_1996_05.JPGMadhu Gritha Abhyanga after Agnikarma

jaims_1996_06.JPG21st day - Using pen tender points were marked


Journal of Ayurveda and Integrated Medical Sciences 2022;7(7)161
Anju D et al: Agnikarma with Kshoudra pain management De Quervain’s Tenosynovitis

jaims_1996_07.JPGDropping of Heated Kshoudra over tender points for 1-2 sec

jaims_1996_08.JPGMadhu Gritha Abhyanga after Agnikarma

Discussion

Probable mode of action of Agnikarma with Kshoudra

Due to the less heat dissipation of Kshoudra, along with its Yogavahi and Ashukari properties, it was equally effective in clearing Sroto Avarodha by Ama Pachana.

Kshoudra possess Vata-Kapha Shamana, Ushna, Tikshana, Laghu, Ruksha, Sukshma Guna when employed for Agnikarma reduces local inflammation; thus results in reduction of pain (Shoola) and improves the range of movements (Kriyavasakthi).

If the Agnikarma with Kshoudra over the base of thumb exceeds more than 2 seconds it will lead to scald formation.

Conclusion

Wrist pain is a very common complaint that can have a dramatic change on the people productivity at work, sporting artistic pursuits and activity of daily living. Agnikarma using Kshoudra acted by the penetration of heat through Sukshma Sira.

Heat of Kshoudra travelled in Dhatwagni level which acted as Ama Pachana and pacified both Vata and Kapha, and removed Srota Avarodha which resulted in pain relief with better aesthetic outcome.

Reference

1. Deepak Nainwal, R. Arunmozhi. A literature review on de-quervain’s tenosynovitis. Int.J.Adv.Res.2020 8(07) {cited April 2022}, 824-835.

2. Kuldeep Kumar. Clinico-Anatomical Review of Snayu with special reference to Sprain. IAMJ {online}.2018 May {cited Feb,2020}; 6(5): 1105-09.

3. Susrutha, Susruthasamhitha, edited by Vaidya Yadavji Trikamji Acharya, Narayan Ram Acharya 'kavyatirtha', Sutrasthana, Ch-12, Ver-3,4,6. Reprint, 2008 ed,Varanasi: Choukhambha Sanskrit Sansthan;p.51-3

4. Prasanth K S, Ravishankar A G. A Comparative study of Agnikarma with Tapta Kshoudra and Pancadhathu Shalaka in Carpel Tunnel Syndrome. IJAAR. 2017 Jul- Aug{cited July,2021};3(3):677-78


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