Dr Sreekumar A
Female 48 yrs came to our OPD on 23/5/05 with severe pain along her right lower limb.She could walk only with support.
Prescribed Bell 30 4 doses and was admitted in female ward Bed No : 62.
The Case was taken in detail and recorded as follows.
Pain Rt Hip
Extending to Rt UL,LL.
< Walking,lying on sides.
> Lying on back.
Pain b/l Breast with heavy feeling.
Low abd. Pain.
History of presenting complaints
C/started as pain along Rt Lower Limb 1 month back.Later pain settled over Rt Hip.
History of past illness
R/c Mastitis more in Lt. since puberty.
Surgically treated 20 yrs back.
Hysterectomy done 2 years back.
Took Allopathic medicines,traction,and used lumbar corset.
FNAC showed features of Tr.Bursitis.
Surgery was adviced.
Father died 25 yrs back.Suffered from Ca.Stomach.
Mother is Hypertensive.
Patient has three children
First daughter – R/c Sinusitis
Second daughter – Renal Complaints
Third son – Nothing relevant.
Born and brought up at Parapanangadi.
Studied upto Third Standard.
Married 26 yrs back.
Appetite : Satisfactory
Thirst : Good
Bowels : Regular
Urine : Normal
Sweat : Very Profuse and Offensive more in axilla
Sleep : Diminished
Prefers lying on sides.
Prefers Covering even in Summer.
Tendency to Suppuration.
Gets exhausted easily.
Menses – Hysterectomy done 2 yrs back
Menses was regular,profuse, with clots
With nausea,aversion to food.
R/c acute Headache Rt sided
Impaired vision since 5 years
Teeth – Caries
General Survey- Conscious,alert,co-operative,supine,moderately built and nourished.No Pallor,cyanosis,icterus or clubbing.No lymphadenopathy.
PR 66/mt,rhythm and volume normal.
RR 24/mt,normal rhythm.
BP 120/80 mm Hg.
Inspection– Normal bone contours,Pelvis tilted up on Lt.Colour and texture normal,No Scars or sinuses.
Palpation – Skin temp ?,Normal bone and soft tissue contours.Local Tenderness +
Movements- All movements are painful esp. abduction.
Measurements – No discrepancy in limb length.
RS – NAD
G.I.System – NAD
Nervous System – NAD
Genito Urinary System – NAD
Provisional Diagnosis : ? TROCHANTERIC BURSTITIS
Hb 12.5gm%,ESR 35
X-Ray – Pelvis,Hip,LS Spine – NAD
USG – NAD
FNAC – Trochanteric Bursitis
Clinical Diagnosis :Trochanteric Bursitis : Why?
Evaluation of Symptoms
Following symptoms were taken for Evaluation –
Pain Rt. LL < Walking,Lying on sides
Pain Rt. Hip
Tendency to suppuration
Gets exhausted easily
Sleep – disturbed easily
Rubrics selected were –
Gen/Covers/Amel/and Desire for
Combined Rubric – Profuse offensive sweat
Hepar,Puls and Silicea covered all the four rubrics.
Silicea was selected.
0/3 was given inorder to repeat frequently.
24/5 – Silicea 0/3 1D
Pain < ,with mental well being and good sleep
27/5 – Silicea 0/3 1D
Pain lower and upper limbs >
30/5 – Silicea 0/3 2D
Gen>. Pain Hip persisting
1/6 – Silicea 0/6 2D
Gen>, Can walk easily
C/o Low abd pain
Blood TC 6,000 N 54%,L 46%,ESR 15
Hb 12.1 gm%RBS 94,Uric Acid 7.2
Urine Pus 3-5,EPI 2-4.
Is the inflammation of the Bursae of Gluteus Medius muscle.
Bursae are synovial lined sacs over bony prominences.
Fibres of Gluteus Medius converge into a flattened tendon and gets inserted to lateral surface of greater trochanter.
Trochanteric Bursae separates this tendon from the anterosuperior area of lateral surface of the trochanter over which it glides.
Trochanteric Bursitis follow mechanical trauma – single or repeated injuries.
Infections – eg. TB.
Mild inflammatory reaction in the wall of bursae.
Effusion of clear fluid within the sac.
Bursal wall gets infiltrated by lymphocytes, plasma cells, macrophages and may show focal calcium deposits.
If the inflammation become chronic abscess formation takes place within the walls of bursae.This may burst through the skin to form sinus.
Later the surface of the greater trochanter gets eroded.
Even collapse of head of Femur can occur.
Pain over the lateral aspect of Hip and Thigh.
Crepitus on flexing and extending Hip.
Routine blood examination
May show evidence of previous fractures, protruding metal implant.
Calcification or shadows suggesting soft tissue swelling.
Stress fractures in athlets,elderly.
Slipped epiphysis in adolescents.
Infections like TB should be ruled out.
Rest is very important.
- Pulsatilla – Smarting, itching, relieved by cold.
- Silicea – Chronic bursitis; pain as if sticking or itching.
- Sticta – Very efficacious in bursitis; with swelling and darting pains.
- Sulphur – Inflamed bursa, with a feeling of formication.
Herings Guiding Symptoms : Bry
Lower Limbs. Inflammation of psoas muscles. Pains in right trochanteric and gluteal region, of an aching, cramplike and bruised kind; (>) at every motion.
A Cyclopedia of Drug pathogenesy vol.1 by Hughes R
Aching, cramp-like, and bruised pains in right trochanteric and gluteal region, worse at every motion; stools dry, large, hard, and very dark.
A manual of Homoeopathic therapeutics by Neatby E
Pathogenesis – RUTA is a drug with a limited but well-defined sphere. It appears to affect both injuriously and curatively the fibrous and bony tissues, especially in the vicinity of joints. Taken experimentally, it causes distress of pain such as would result from traumatism or over-exertion of the part affected, or of the body as a whole.
Chronic synovitis and bursitis are often benefited by rue,even when given by routine, as in housemaid’s knee,” or in ganglion about the wrist tendons
CompleteRepertory/Generalities/Infla-mmation/Bursae of/Bursitis – 6
2 Bellis ,Lycopersicum ,Sticta ,Sulphur.
CompleteRepertory/Extremity Pain/Lower Limb/Hips/Trochanteric major/Right – Cicuta 1.
CompleteRepertory/Extremity Pain/Lower Limb/Thigh/Trochanter -Asterias,Verat-vir.
Allen’s Rep/Hip;Trochanter major, region of; Trochanter, under, pain, right – Arum Trip
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