Rotator cuff tendinitis managed with homeopathic medicine

Dr Swetha, Dr Vijayakrishna V

ABSTRACT
Rotator cuff tendonitis is an inflammation of the tendons that make up the rotator cuff, i.e., supraspinatus, infraspinatus, teres minor, and subscapularis. This condition is often seen along with shoulder impingement and can present acutely following an injury or as a result of chronic, repetitive overuse activities¹.  conventional treatment reduced the severity of symptoms but the pathogenesis is unclear managed with immune suppressive drug , analgesics,  most cases progress to complications which may amount to great burden¹. The patient of rotator cuff tendinitis  in a 45years old woman who was treated with individualized homeopathy for 3days with improvement.

INTRODUCTION
Shoulder pain is the third most common musculoskeletal pain and is estimated to compose 16% of all cases of musculoskeletal pain in primary medical care^1.

Both passive and active range of motion should be performed in each of the 3 planes of motion (flexion-extension, internal-external rotation, abduction-adduction) and compared with findings from the contralateral shoulder². Rotation should be tested at 0° and 90° of shoulder abduction. The normal ranges of shoulder motion are listed in  Overhead athletes can develop physiologic decreases in internal rotation with the arm at 90° of abduction. However, these athletes have an increase in external rotation and, therefore, total arch of motion is preserved. Any limitation of active motion in comparison with passive motion suggests an injury to the musculotendinous unit. If both active and passive ranges of motion are diminished equally, a diagnosis of adhesive capsulitis would be suggested. There are 15 musculoskeletal pain cases per 1,000 primary medical care cases each year, totaling about 1% of all adults receiving primary medical care annually Patients who experience shoulder pain for more than 1 year compose 60% of all shoulder pain patients; if not treated, these patients will experience severe disabilities, poor quality of life, and loss of occupation^3.

Rotator cuff diseases of the shoulder appear with a high prevalence in elderly people and result in a decrease in shoulder function². Shoulder pain and dysfunction is a complex problem frequently encountered by primary care physicians. Common nonarthritic conditions seen in the primary care setting include rotator cuff syndrome, impingement, posttraumatic stiffness, adhesive capsulitis, and instability⁴. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy Short-term efficacy of corticosteroid injections for rotator-cuff tendinopathy is not clear.  who received corticosteroid injections in studies that reported adverse events. he value of pulsed electromagnetic fields (PEMF) for the treatment  PEMF therapy may thus be useful in the treatment of severe and persistent rotator cuff and possibly other chronic tendon lesions. comorbidities associated with rotator cuff disease. These include lateral epicondylitis, carpal tunnel syndrome, trigger finger, Achilles tendinitis, oral corticosteroid use, diabetes mellitus, and overweight BMI. cyclooxygenase-2 inhibitors can produce a decrease in the levels of stromal cell-derived factor 1, an important cytokine associated with production of bursal inflammation⁵.PRP has positive effects on healing during shoulder capsulitis intervention decrease the pain and increase the upper limb function also it can improve range of shoulder motion⁷. the intra articular corticosteroid infiltration is effective in the treatment of frozen shoulder^6.

CASE PRESENTATION

• The 45 year old  female patient presented with complaint of bilateral shoulder joint pain since 2months aggravated since a week.
• Even with conventional treatment the pain was constant
• Characteristics symptoms which plays important role the patient describe the pain of both upper limbs   aggravation on every slight movement, even slight pressure on painful side
• Patient describe her menstrual complaints used to be better once the flow starts I feel free this characteristic made to think the confirmatory symptom the pain of both the shoulder joint which is used to aggravate sleep after . Personal history and Generals. She was thirstless towards hot.

Past h/o

H/o Organophosphorus poisoning (suicidal attempt) 10 years back , hospitalized for the same recovered after a month.

She is physically handicapped (polio of the right leg).

Mental / emotional state- she is handicapped since from the childhood because of polio early arrange marriage at the age 20 years of age the major set backs started since then husband was chronic alcoholic was physically abused everyday there was an incident were he stripped her clothes infront of neighbours and physically abused she ran out of from her home she  felt embrassed , insulted decided to end her life, and consumed insectide she rescued from death by daughter and neighbour. Since then she started working hardly as a tailor to look after children health education , was very determined I don’t accept any help , I am capable of working I do not want to depend on anyone.

Locomotor system examination- on palpation- warmth , rigidity of muscle bilateral-

Tenderness was marked

Movements – aggravation

GYNECOLOGICAL HISTORY
The patient attained menarche at the age of 14 years since menarche irregular has not been treated with any medication it resolved on its own, she used to complaint severe chest pain menses before which used to better with flow of menstrual bleeding.

ANALYSIS OF CASE:

COMMON

• Pain during all movements of shoulder joint.
• Lying on painful side aggravation.

UNCOMMON

• Swelling of fingers and palms during pain
• < during and after sleep

( sleeping into aggravation )

• Pain as if limbs were cut off.
• Thirstless
• Irregular profuse menses with pain

> by flow

• Thermally HOT
• Extreme weakness of body.
• Self respect++
• Ashamed feeling.
• Aversion to tobacco smoke
• Abdominal pain gripping type.
• Unconsciousness during pain

TOTALITY OF SYMPTOMS

• Opens up easily
• Feeling of embarrassment which led her to kill herself.
• Self respect
• Hates sympathy.
• Wants to be independent.
• Mental disposition changed from mild, gentle and enduring to rude, reacting and hurting.
• Aversion to tobacco smoke
• Menses: Irregular

Profuse

Pain present

>by onset of

flow.

• Sensation as if though the limb was cut.
• <lying on painful side
• < after sleep
• Abdominal pain gripping type.
• Unconsciousness during pain.

REPERTORIAL TOTALITY

• MIND – AILMENTS FROM – EMBARRASSMENT
• MIND – COMMUNICATIVE
• MIND – EGOTISM
• MIND – UNCONSCIOUS – PAIN, FROM
• ABDOMEN – PAIN – CRAMPING
• FEMALE GENITALIA – MENSES – PAINFUL
• FEMALE GENITALIA – MENSES – PAINFUL – FLOW – AMELIORATION
• EXTREMITIES – PAIN – UPPERLIMB – PAIN,BROKEN AS IF
• EXTREMITIES – PAIN – UPPER ARMS – RAISING ARM AGGRAVATION
• GENERALS – SLEEP – DURING SLEEP – AGGRAVATION

Prescription: 

Based on totality of symptoms presented he was prescribed

lachesis 30 C one dose

Within 2 hours of medication immediate rise of temperature with subsided gradually with FP6X every hourly within 4 hours it resolved  with the improvement of movement of both the hands within 3 days with no comorbidities

REFERENCES

1. C. VECCHIO, B. L. HAZLEMAN, R. H. KING, A DOUBLE-BLIND TRIAL COMPARING SUBACROMIAL METHYLPREDNISOLONE AND LIGNOCALNE IN ACUTE ROTATOR CUFF TENDINITIS, Rheumatology, Volume 32, Issue 8, August 1993, Pages 743–745, https://doi.org/10.1093/rheumatology/32.8.743
2. Harrison, Alicia K. MD; Flatow, Evan L. MD. Subacromial Impingement Syndrome. American Academy of Orthopaedic Surgeon 19(11):p 701-708, November 2011.
3. Varacallo M, El Bitar Y, Mair SD. Rotator Cuff Tendonitis. [Updated 2023 Aug 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532270/
4. Lewis JS. Rotator cuff tendinopathy. British journal of sports medicine. 2009 Apr 1;43(4):236-4
5. Kraal T, Sierevelt I, van Deurzen D, van den Bekerom MP, Beimers L. Corticosteroid injection alone vs additional physiotherapy treatment in early stage frozen shoulders. World J Orthop. 2018 Sep 18;9(9):165-172. doi: 10.5312/wjo.v9.i9.165. PMID: 30254973; PMCID: PMC6153137.
6. Nazim ZK, Farhat MF, Abbasi S. Comparison between Intra-Articular Steroid Injection and Supra-Scapular Nerve Block in the Management of Frozen Shoulder. Pak J Med Sci. 2024 Aug;40(7):1415-1419. doi: 10.12669/pjms.40.7.8531. PMID: 39092040; PMCID: PMC11255801.
7.  slani H, Nourbakhsh ST, Zafarani Z, et al. Platelet-Rich Plasma for Frozen Shoulder: A Case Report. Arch Bone Jt Surg. 2016;4(1):90-93.
8. Lo CN, van Griensven H, Lewis J. Rotator cuff related shoulder pain: An update of potential pathoaetiological factors. NZJP [Internet]. 2023 May 10 [cited 2024 Oct. 3];50(2):82–93. Available from: https://nzjp.org.nz/nzjp/article/view/318
9. e Witte, P.B., van Adrichem, R.A., Selten, J.W. et al. Radiological and clinical predictors of long-term outcome in rotator cuff calcific tendinitis. Eur Radiol 26, 3401–3411 (2016). https://doi.org/10.1007/s00330-016-4224-7
10. ompagnoni, R., Menon, A., Radaelli, S. et al. Long-term evolution of calcific tendinitis of the rotator cuff: clinical and radiological evaluation 10 years after diagnosis. J Orthop Traumatol 22, 42 (2021). https://doi.org/10.1186/s10195-021-00604-9
11. Hand C, Clipsham K, Rees JL, Carr AJ. Long-term outcome of frozen shoulder. Journal of shoulder and elbow surgery. 2008 Mar 1;17(2):231-6.

Dr Swetha¹, Dr Vijayakrishna V²
1.Post graduate scholar, Dept of homoeopathic material medica , GHMC and H, Bengaluru 560079.
2. BHMS, MD Prof and Pg guide ,Department of Materia Medica GHMC and H, Bengaluru 560079