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Case Study-Cervical Radiculopathy PowerPoint Presentation

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Description : Diagnosis of patient with Cervical Radiculopathy.

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Published on : Sep 24, 2023 | Views : 2061 | Downloads : 1

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Dr . Sreelakshmi Raj 1st year PG Scholar Department of Panchakarma SKAMCH&RC Guide Dr . Kiran M. Goud Co-Guide Dr . Supreeth M.J. CASE PRESENTATION 1
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Name : xyz Age : 40 years Sex : Male Religion : Hindu Socio-Economic status : Middle class Marital status : Married Education status : High school Occupation : Real estate Address : Nagarabhavi, Bangalore Preliminary daTA 2
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Date of Admission : 6/06/2023 Date of Discharge :20/06/2023 OP No : K15664 IP No : 2620/23 Ward/Bed no. : Male General Ward / Bed-01 Source of History : Patient Case taken on : 10/06/2023 Consultant Doctor : Dr. Kiran M Goud 3
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PRADHANA VEDANA C/O PAIN IN THE NAPE OF NECK REGION RADIATING TO LEFT UPPERLIMB UPTO FOREARM X 2 MONTHS 4
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ANUBANDHA VEDANA Associated with C/O Numbness in left little finger Numbness in lower abdomen X 2 months 5
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Patient was apparently normal 2 months ago. One day morning patient got mild pain in the neck but he neglected it. After 3 days, he had severe intolerable pain with inability to do the daily activities. He, then, consulted a near by doctor who prescribed some pain killers[details unknown]. After taking the tablets, he still did not feel any relief. For the same, he again consulted an orthopedist. There as well, they had given some pain killers and advised an MRI of spine. Meanwhile, the pain started to radiate to the back side of left shoulder, left arm and left forearm , hand and in fingers with numbness of all the fingers of the left hand. Consequently, he visited Rajarajeswari medical college hospital and did an MRI of spine and consulted an ortho-surgeon who advised some oral medications and referred to a Neuro-surgeon. ADYATANA VYADHI VRUTTANTA 6
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Because of some personal emergency, he didn’t consult there and came back home. After a few days, he found difficulty in lifting any heavy object using the left hand, compared to the right hand. The pain also increases while lifting heavy objects. Slowly, he felt weakness, difficulty in day to day activities and reduced strength of left hand. For this, he approached an acupuncture clinic where he found some immediate relief after acupuncture, but pain started aggravating back by evening, and he had severe catching pain at night time in neck which radiated to the left hand. He also found a slight relief in this pain when a hot water bag was placed. Within 3-4 days after the acupuncture, he noticed a change in sensation when touching the left hand ,fingers of left hand , lower abdomen and lower back compared to other parts of his abdomen, upper and middle back and continuity of the pain. 7
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For these complaints, he visited SDM Kengeri. They advised him some oral medicine but he was not satisfied with the prescription and wanted to take some massage for the same. Eventually, He approached SKAMCH & RC. He undertook a treatment for 12 days and felt a relief of radiating pain by 50%[now pain in the nape on neck radiating till forearm]. The strength and power of left hand had improved , complaints of numbness in hand and fingers also had reduced but still persists only in the left little finger. The numbness of lower back region has reduced but numbness of abdomen still persists. The above complaints still causes difficulties in day-to-day activities. For complete recovery, he approached SKAMCH & RC again. 8
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POORVA VYADHI VRUTTANTA Not a K/C/O DM, HTN, Hypothyroidism. No H/O COVID-19 9
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SURGICAL HISTORY No history of Surgeries. 10
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OCCUPATIONAL HISTORY WORKING AS REAL ESTATE AGENT USED TO TRAVEL DAILY ~ 50 KM IN 2 WHEELER SOME TIMES IN CAR 11
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TREATMENT HISTORY ORALLY 1] TAB NEURICA 75 MG [0-0-1] X 10 DAYS [ stopped ] 2]TAB ZERODOL –SP [1-0-1] X 10 DAYS[ stopped] CAP STRESSCOM [1-0-1] CAP PALSINEURON[1-1-1] TAB MRUTHYUNJAYA RASA[1-1-1] TREATMENT TAKEN GREEVA BASTI WITH MOORCHITA TAILA SARVANGA ABHYANGA WITH MOORCHITA TAILA SARVANGA PARISEKA WITH DASHAMOOLA QWATHA NASYA WITH MASHA TAILA [10* E/N] 12 days 5 days 12
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VAYAKTIKA VRUTTANTA Diet - Mixed, Katu , Lavana Rasa pradhana , Rooksha Appetite - Good Sleep - 7 to 8 hours, sound sleep Micturition - 3-4 times during day, Bowel - Regular, once/ twice in a day. Habits - Smoking : about 4-5 cigarettes / day since 10 years - Alcohol : about 180 ml /day since 10 years - Tea : 5-6 times/day 13
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KOUTUMBIKA VRITTANTA PATIENT All Family Members Are Said To Be Healthy 14
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ROGI PAREEKSHA 15
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SAMANYA PAREEKSHA Built - Moderately built Nourishment - Moderately nourished Pallor - Absent Icterus - Absent Cyanosis - Absent Clubbing - Absent Lymphadenopathy - Absent Edema - Absent 16
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Tongue - Non coated Temp - 98.60 F Pulse - 74 bpm B.P - 130/80 mm of Hg Respiratory - 18 cycles / min Height - 163 cm Weight - 66kg BMI - 24.8 kg/m2 Gait - Normal 17
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ASHTA STHANA PAREEKSHA Nadi - 74bpm Mootra - 3-4 times a day Mala - Regular, once/twice in a day. Jihwa - Alipta Shabda - Prakruta Sparsha - Anushna sheeta Drik - Prakruta Akriti - Madhyama 18
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DASHA VIDHA PAREEKSHA Prakruti – Vata -pitta Vikruti Hetu: Aharaja: Ati Katu, Ati lavana , Rooksha[fried] , Viharaja: Smoking, madyapana, excessive mobile usage [5-6hr/day] , Atiyaana[2-wheeler daily ~50km], Vegadharana. Manasika: Chinta ,Krodha Dosha: Vata, 19
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Dushya – Rasa ,raktha, mamsa , meda , asthi, snayu Desha - Sadharana Kala - Varsha ritu Bala - Madyama Sara -Madyama Samhanana -Madyama Pramana -Madyama Satmya - Vyamishra satmya Satva - Madyama 20
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Aahara Shakti Abhyavaharana Shakti - Madyama Jarana Shakti - Madyama Vyayama Shakti - Madyama Vaya - Madyama/parihani 21
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SYSTEMIC EXAMINATION 22
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CARDIOVASCULAR SYSTEM Inspection No visible veins/scars/discoloration No visible pulsations Palpation Apical impulse felt at 5th intercostal space 0.5 inch medial to the mid-clavicle line and 3.5 cm away from mid-sternal line Percussion Cardiac dullness heard on left side. Auscultation S1, S2 heard, no added sounds
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RESPIRATORY SYSTEM Inspection – * Shape of chest –Bilaterally symmetrical * Chest movements- Symmetrical * Abdomino-thoracic breathing seen * Respiratory rate – 18 cycles/min Palpation Trachea - Centrally placed Percussion – Resonant over the lung field except cardiac dullness. Auscultation - Normal vesicular breath sounds heard , no added sound 24
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GASTRO INTESTINAL EXAMINATION Inspection – Tongue – Not coated No mouth ulcers Shape – Rounded. Umbilicus – centrally placed, Inverted. No visible veins and scars Palpation – Soft, Non tender. Percussion – Tympanic sound heard Auscultation – Bowel sounds heard Abdominal reflex - Normal 25
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NERVOUS SYSTEM Higher Mental Functions- *Consciousness - Conscious *Orientation to Time, place, person - Intact * Memory - Intact * Intelligence - Intact * Hallucination & Delusion - Absent * Speech disturbance - Absent * Cordination - Intact 26
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MUSCULOSKELETAL SYSTEM EXAMINATION SHOULDER JOINT INSPECTION : No Swelling , No scar , No Discoloration PALPATION : No Tenderness , No Warmth-ness 27
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ELBOW JOINT INSPECTION : No Swelling , No scar , No Discoloration PALPATION : No Tenderness , No Warmth-ness 28
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WRIST JOINT INSPECTION : No Swelling , No scar , No Discoloration PALPATION : No Tenderness , No Warmth-ness 29
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MUSCLE POWER MUSCLE TONE NORMOTONIC REFLEXES 30
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SPINE EXAMINATION : CERVICAL INSPECTION : Curvature – Normal, No Swelling, No scar, No Discoloration PALPATION : Tenderness – absent 31
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SENSORY EXAMINATION 32
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INVESTIGATION 33
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NIDANA AHARA – Ati lavana , ati katu , fried oily food , VIHARA – Atiyana , madhyapana , smoking , continuous usage of mobile for 5-6 hrs MANASIKA – Atichinta , krodha ROOPA - Pain in neck radiating to left upper limb UPASHAYA – Taking rest , application of hot water bag SAMPRAPTI - NIDANA PANCHAKA 37
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Vyana Vataprakopa Sthanasamshraya in greeva and bahu prishta Aashraya in greeva pradesha and causes dhatu kshaya and shoshana of greeva kaseruka sandhi leading to dushti of kandara of bahu Leading to symptoms like pain in the nape of neck radiating till forearm and Karma kshaya 38 Mamsa shithilatha Sandhim Vimuchyate Vidahyate Raktham Viharaja Nidanas like atiyana , smoking , drinking alcohol, excessive usage of mobile Aharaja Nidanas like atikatu atilavana , oil fried food Manasika Nidanas like chintha, krodha
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DOSHA - Vata-Vyana vata DOOSHYA – Rasa , Raktha , Mamsa , Asthi , Majja , Sira , Snayu , Kandara SROTAS - Mamsavaha , Asthivaha , Majjavaha SROTO DUSTI PRAKARA- Sanga. AGNI – Jataragni , Dhatvagni. AMA – Jataragnimandyajanya , Dhatvagnimandyajanya. ROGA MARGA - Madhyama. SAMPRAPTI GHATAKA 39
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UDBHAVASTHANA - Pakvashaya. SANCHARASTHANA – greeva, manya, vama bahu, prathyanguli ADHISHTANA – Greeva , Manya Bahupradesha , Pratyanguli , Kandara , Bahuprusta. VYAKTASTHANA – Greeva, Manya, Talapradesha , bahu SADHYASADYATA - Kashta sadhya VYADHI SWABHAVA - Chirakari 40
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1] MANYA STHAMBA 2] AVABHAHUKA 3] EKANGA VATA 4] VISHWACHI 1]CERVICAL SPONDYLOSIS 2]BRACHIAL NEURALGIA 3]CERVICAL RADICULOPATHY VYAVACHEDAKA NIDANA 41
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VYAVACHEDAKA NIDANA 42
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43
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VAMA BHAGA VISHWACHI CERVICAL RADICULOPATHY OF LEFT HAND FINAL DIAGNOSIS 44
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गृध्रसीविश्वाचीक्रोष्टुकशिरःखञ्जपङ्गुलवातकण्टकपाददाहपादहर्षावबाहुकबाधिर्यधमनीगतवातरोगेषु [१] यथोक्तं यथोद्देशं च सिराव्यधं कुर्यात् , अन्यत्रावबाहुकात्; वातव्याधिचिकित्सितं चावेक्षेत || (Su. Chi 5/23) CHIKITSA SOOTRA 45
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According to Ashtanga Sangraha अपबाहुके नावनमूर्ध्वभक्तं च निरामे स्नेहपानम्| विश्वभीप्रभृतिषु पाददाहान्तेषु यथोक्तां सिरां विद्ध्वा वात व्याधिवदुपाचरेत्|| (A.San Chi 23/28) CHIKITSA SOOTRA 46
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According to Yogaratnakara दशमूलीबलामाशक्वाथं तैलाज्यमिश्रतम्। सायं भुक्त्वा चरेन्नस्यां विश्वाच्यां चावबाहुके|| [vata vyadhi chikitsa – 144] CHIKITSA SOOTRA 47
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TREATMENT 48
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Nidhana Parivarjana [Atikatu atilavana , oil fried food, Atiyana, smoking , drinking , excessive usage of mobile, Vegadharana, chintha, krodha] Greeva basti with [prasaranyadi taila] Sthanika abhyanga with prasaranyadi thaila [ neck and left hand] Sthanika nadi sweda [ neck and left hand] Nasya karma with karpasasthyadhi tailam 8 bindu ORALLY Prasaranyadi Kashaya [15ml-0-15 ml with 45 ml of water] B/F vishatinduka vati [2-2-2] A/F PROPOSED LINE OF TREATMENT 7 days 50 7 days
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PATHYA Intake of laghu , ushna, snigdha ahara Shastika shaali APATHYA Ati katu , Atilavana , rooksha Smoking and madhyapana Vegadharana Atiyana, Athichintha PATHYA APATHYA 51
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THANK YOU