1. INTRODUCTION
The Almighty gave us legs to walk on gave us mobility; to carry us from place to place and gave us hands to be creative, to perform the daily chores of life and to carry the burden of mankind.
Primitive hunting man used to walk miles to hunt food for himself and his family. He had to have strong legs to do this day in and day out. Since there was never any certainty where he would go and what he would find, his limbs were tuned to work that extra mile or two if the need arose. In those days, limbs or rather the joints served man faithfully for really long number of years and most mortals were mobile till death.

2. From Home  elevator  car  Office  elevator.
But then came the Industrial Evolution and Man had to develop different faculties. The joints were used less and less till life became almost sedentary :
From Home  elevator  car  Office  elevator.
The only exercise people indulged in is climbing walls and jumping to conclusions! The joints now had to be prescribed exercise by doctors, as a must for maintaining mobility and good health.
As a result of disuse – joints stiffened, synovial fluid dried up, joints started degenerating earlier. Every which way you looked at it, the joint refused to cooperate. What more can you call spondylitis in early 30s and sever OA knee in mid 40s?

3. There are more joints in the child than in an adult.
Definition :
It is a junction between two o more bones or cartilage.
It is a device to permit movements.
There are more joints in the child than in an adult.

4. Classification of Joints
Functional
1) Synapthrosis Immovable It.
2) Amphiarthosis - Slights movable
3) Diarthrosis Freely movable
Structural Classification
Fibrous Joint
2,Cartilaginous Joints
* Synchonorosis or Hyaline Cartilage Joints.
It B/w Epiphysis and diphysis of a growing long bone.
Example :
Spheno – Occipital Bone.
Costochondral and Coststernal Joint.
* Symphysis or fibro cartilaginous Joints.
Example: Symphysis pubis
Manabrio sternal joint

5. 3. Synovial Joints or Diarthrodial Joints
Also k/s Freely movable joints
The ends of tow bones are held together by joint capsule, with ligaments and tendons inserted at the outer surface of capsule.
A synovial joint has a fluid filled cavity. The fluid is known as synovial fluid (produced)
Synovial fluid acts as lubricant.
Most of the disease of Joints affected Diarthrodial or Synovial Joints.

6. Types of Synovial Joints & their movements
1 .Plane or Gliding movement
Example Intercarnel Joints
Inter tarsal joints
Joints b/w bertebras
Movements – Gliding movements.

7. Hinge Joints Uniaxial Joints Movements are limited in one plane.
Example - elbow joint
Ankle joint
Interphalangeal joints
movements - Flexion & extension

8. Pivoto Joints Condoyle Joints Uniaxial Joints
Example superior and inferior radio ulnar.
Median Atlanto axial joints
Movement Rotation only
Condoyle Joints
Joints permit movements mainly in one plane around
transverse axial but partly in another plane around vertical axis.
Movement possible – Flexion & extension & limited
rotation.
Example Knee joint
right & left Saw joints 260

9. Ellipsoid Joints Saddle Joint (Seller) Biaxial Joints
Free movement are permitted around both the axis.
Movements Possible –Flexion, Extension
abduction, adduction and circumduction.
Example - wrist Joints
Metacarpophalengeal joints.
Saddle Joint (Seller)
Multiaxial Joints
Move possible-- Flexion, Extension, adduction, abduction
and conduct rotation.
Example  Sternoclavicular joint
Calcaneocuboid joint

10. Ball and socket Joint (Spherodial)
Multiaxial joint
Movements occurs around and
indefinite number of axes which have
common centre.
Movements-Flexion, extension,
abduction, adduction,
medial rotation,
Lateral rotation and
circumduction.
Example - Shoulder joint
Hip joint
Talocalcaneonavicular joint

11. Factor maintaining stability of joint
Muscles
Ligaments
Bones

12. Aging & Joints
With aging, a decrease in synovial fluid, thinning articular cartilage and decrease flexibility ligament occur.
Most individual experience some degeneration is the knees, elbows, hips and shoulder due to aging presses.

13. ARTHRITIS It is a form of Rheumatism in which joints have become
inflamed and painful
Characterized by
Inflammation, Pain
and stiffness and moving
usability
Arthritis affects about 10 %
people of world Population.
Most common in older Aged
people due thinking of
particular cartilage and
decrease in
synovial fluid

15. Also due to injury, Truma, Allergy and infections disease spread such as
Tuberculosis.
Gonococcal
Syphilitic etc.

16. Important cause of Arthritis
Diffused connection tissue disease such as RA
Degenerative joint disease such as OA.
3.Metabolic and endocrine Disease
such as Gouty Arthritis.

17. CLINICAL MANIFESTATION
Arthralgia - Pains in Joint
Chondritis - Inflammation of Cartilage
(3 Synovitis Inflation of a Synovial membrane.
in joint.

18. CLASIFICATION OF ARTHRITIS Arthritis with psoriasis
1. Rheumatoid Arthritis – and its variants such as
Arthritis with psoriasis
Juvenile rheumatoid arthritis
Rheumatic spondylitis
Reiter’s syndrome
Arthritis due to rheumatic fever.
3. Osteoarthritis.

19. 4.Arthritis associated with known infectious agents – e.g.
Gonococcal,
Tuberculoses – most common
Involve – spine, hip join &
Knee joints
Tuberculosis of spine is
termed as POTTS DISEASE
Spondylitis.
Syphilitic –
Pneumococcal, etc.

20. Associated with metabolic or bio-chemical
or endocrine abnormalities -
Gout, hemoglobinopathies, onchronosis,
acromegaly, etc.
6.Traumatic arthritis
7.Neuropathic arthritis
8.Allergy and drug reaction.

21. 10. Connective tissue disease – S.L.E. Polyarhteritis nodosa,
9. Arthritis with blood disorders
10. Connective tissue disease –
S.L.E.
Polyarhteritis nodosa,
Dermatomyositis.
11. Miscellaneous Disorders -
Amyloidosis
Erythema multiform,
Ulcerative colitis,
Sarcoidosis

22. OSTEOARTHRITIS (O.A) Also called as Osteorthrosis or
Degenerative Joint Disease
Result from a combination of aging,
irritation of joints, wear and abrasion.
Commonly known as wear and tear
arthritis and
leading cause of disability in older
individuals.
Most common form of chronic
disorder of synovial joints
particulars weight bearing joint

23. In Older Age. The Articular cartilage show
Degenerative changes in CENTRE (Fibrillation of
cartilage)
And
Proliferative change around the edges (Osteophytes )
It is characterized by :
Degeneration of the cartilage with associated over growth of bone at the margin of joints
And
Changes in synovial membrane
Affect up to 10% of world population

24. IT COMMONLY INVOLVES :

25. The proximal Interphalangeal finger joints – to form bony swelling –
The distal IP joints of the fingers- to form
bony swelling – The Heber den nodes.
The proximal Interphalangeal finger
joints – to form bony swelling –
The Bouchard nodes

26. The lumbar spine –
lumbar spondylitis

27. The cervical spine –
cervical spondylitis.

28. The large joints –
including Hips and Knees.

29. Pathogenesis PRIIMARY– OESTEOARTHRITIES 
Occur more commonly in women than men .
Progress begin by end of 4th decade.
Pathogenesis
Wear and tear with repeated minor trauma,
heredity AND obesity.

30. Secondary Osteoarthritis 
-May appear at any age.
-Results from any previous injury, fracture
inflammation and congenital dislocation of the hip.
Clinical manifestaslation :
Joint stiffness. Diminished mobility, pair
etc.
The symptom are prominent on walking up
from
the Bed in morning. .

31. The degenerative changes in the
interphalenges joints
lead to hard bony and pain less modules
at the base of terminal.
Its phalanx called as HEBERDEN”S NODES.

32. HEBERDEN”S NODES

33. Pathos Physiology of
secondary osteoarthritis

34. Thicking of jointCauses swelling.
Most marked in weight – bearing region.
Initially
Loss of cartilaginous matrix
Resulting
Progressive loss of normal metachron
Focal loss of chondrocytes
Causes
Loosening, flaking and fissuring of Articular cartilage.
Resulting
Breaking off of pieces of cartilage.
Developing of Osteophytes.
Thicking of jointCauses swelling.

35. MACHINICAL SYMPTOMS ARE CHARACTERRIZED BY:
Pain: The pain is usually relieved by rest. Night pain may be a feature. Pain on weight- bearing, if the lower limb joints are involved.
Stiffness after rest: usually lasting less than 5 minutes – with the patient loosening up quickly by moving the joints. Morning stiffness is not a prominent feature and short lived if present at all.
Swelling is usually bony rather than soft tissue in character.

36. Risk factors: Age Obesity Repetitive stress injury / trauma to joints.
Sex – Female are more frequently involved (10:1)
Genetics – this is a problem often seen within families.
Other diseases causing cartilage damage – resulting in
secondary osteoarthritis.

37. X RAY OF NORMAL KNEE JOINT

38. X RAY OF OSTEORITHRITIC KNEE

39. OSTEOARTHRITIS OF
KNEE
Most commonly affected joints found in clinical practice. Joint space narrowing with Osteophytes (new bone formation) and loose bodies are seen.
The patellofemoral articulation is the most commonly affected with medical tibiofemoral compartment being second.
In early disease, spiking of the tibial tubercles and marginal Osteophytes are seen.

40. OSTEORTHITIS OF THE HIP JOINT
This is the second most affected joint in the body.
Secondary osteoarthritis following:
Congenital dysplasia. PERTH’S DISEASE
congenital dislocation, slipped epiphysis, Aseptic necrosis etc is more common than primary osteoarthritis.
Joint space reduction and marginal osieophyisis are seen. The femoral head migrates either superiorly or medially. A-P views of the hip usually provide adequate information.
In certain cases, a CT scan show areas of subaiticular crescents as in aseptic necrosis or geode formation in advanced cases.

41. NORMAL X RAY OF THE
HIP JOINT

42. OSTEORTHITIS OF THE
HIP JOINT

43. OSTEOARTHRITIS OF THE HANDS
In osteoarthritis, the distal interphalageal joints are most commonly affected with joint space narrowing and large peripheral osteophytes resulting in the clinically evident
“Heber dens nodes “

44. X RAY OF ARTHITIS OF
THE TOE JOINT

45. RHEUMATOID ARTHRITIS Definition –
A systemic connective tissue disorder which affects
predominantly
the synovial joints, hence the term rheumatoid disease.
Its systemic manifestation include
hematological,
pulmonary, neurological & CVS abnormalities

46. Etiology : Age – any age, majority Between 20-40.
Sex – more in females than males = 5:1
Climate – in temperature climate.
Familial tendency.
Genetic factors.
Sex hormones – more in female than in
males.
7.Psychological factor – Physical
8.Exposure to cold & wet.
9.Trauma:
Arthritis may start in a joint which
has been the seat of trauma and
other joints subsequent get involved.
10.Environmental triggers.

47. EITIOPATHOGENISIS OF REHEVMATOID ARTHERITIS
IMMUNOLOGIC FACTORS
(II) GENETIC FACTOR

48. Genetic susceptibility
( MHC – Class – II )
Antigenic stimulation
( By infections agent )
CD4 + T –Cells
Cytokines
( TNF – α, INF – γ, IL -1)
Activate Activate Activate
B – Cells Endothelial Cell Macrophages
Anti IgG – antibody Release of adhesion Cytokines
(Rheumatoid factor) molecule Protease
Formation of immune complex, Inflammatory Cells,
Inflammatory damage to synovium, small vessel collagen
Destruction of cartilage bone fibrosis, ankylosi
joint Deformities

49. Types of Presentation:-
1.Classical –
Pain, stiffness and swelling of small joints of head,
wrists.
2.Palindromic –
Pain, swelling and redness usually of a single joint,
followed by rapid return to normal after several days.
3. Systemic -
Weight loss, Pleurisy and pericarditis but minimal joint
involvement.
4. Polycyclic -
Plain and stiffness in shoulders and hips with
subsequent synoptic.
5. Monoarthritic -
Single joint involvement usually the knee.
6. Acute Onset -
Sudden overnight onset with stiffness and pain.
7. With generalized lymphadenopthy.

50. Clinical Features :- In early stage –
Joints are warm, swollen and tender.
Weakening of joints, capsule and tendon along
with ligament damage.
Instability, subluxation, dislocation.
Severe joint damage may lead to fibrous or body ankylosis

51. secondary degenerative changes.
1.Hands -
Tenosynovitis (inability to appose
the palms)
Rupture of flexor/ extensor tendons
with weakness of grip.
2.Legs -
Knees – synovial effusion
Ankles – Valgus deformity
3.Cervical Spin -

52. 1.Skin - Palmer erythematic
Rashes Psoriasis.
2.Myositis Muscle wasting around inflamed
joints
3.Bone Generalized osteoporosis
4.Eye Keratoconjunctivitis scleritis
5.Heart Pericarditis
Myocarditis
Rheumatoid Vulvulitis.
6.Blood Anemia (mild normocytic
norm chromic anemia)
G.I. bleeding by Aspirin and other
Analgesics.
7.Respiratory Pleurisy and ale Ural effusion
Rheumatoid nodules
Pulmonary hypertension

53. 8.Nervous System - Neuropathy
Nerve root compression
Pain
Numbness or Paraesthesiae
9.Kidney Proteinuria
Microscopic heaematuria
10.Investigation E.S.R. (elevated)
R.A. Factor
S.L.E.
11.Radiology Reduced of joint space
X-ray
bone Deformity

54. X-RAY & bone Deformity

55. GOUTY ARTHRITIS
In Gouty Arthritis, sodium create crystals are deposited in the soft tissue of the joints.
The crystal irritate and erode the cartilage causing The person who suffers from govt. either produce excessive uric acid or is unable to excrete as much as normal.
Result in building up uric acids in the blood.
Uric acid + sodium ↓
Crystal of Sod. Ureate
Deposited in the soft tissue of the joints.

56. DIAGNOSIS OF ARTHRITIS
1. PHYSICAL EXAMINATION
Whenever a patient presents with a problem joint, the primary care physician has to picture All the structures that makes up a joint. Any one or more of the following may be involved:
Trauma
Degenerative changes
Infection: both acute and chronic and
Neoplastic

57. If a Patient is looking with pain in joint
the pain can be of three things.
Bone
Muscle
Nerve
Examination of – Swelling /Edema
Tender
Redness
Any eruption
Tortuousness of veins
Hot/cold ( temperature )
Movement
Sound (cracking )

58. To complete the list, metabolic (gout) & Neoplastic causes also have to be kept in mind.
On the other hand the joint may be affected as part of a widespread systemic disease – Rheumatoid arthritis and other seronegative spondyloarthropathies.
When a patient presents with any joint pain, it is the duty of the physician to assess the entire locomotors system:

59. ESTABLISH THE EXTENT OF ABILITY OR DISABILITY
To carry out routine, day-to-day chores.
Eg in rheumatoid arthritis can he open / shut a zip or unbutton her blouse; what are the activities which are not possible now and
should be our first target at improvement.
Ask the patient:
Can you climb stairs?
Can you dress normally?
Are you free from any muscle stiffness any
where in the body?
If the answer is No. go into details an
if the answer is yes, it is unlikely that the
patient has any significant involvement
in affection of a joint / muscle group.

61. OBSERVATION
Ask the patient to disrobe as much as is comfortable for both the physician and the patient. Ideally patient should be in undergarments.
Stand away from the patient and observe closely as the patient carries out your instructions.
Observe the patient from behind to
Assess the buttocks, shoulder, Para spinal muscles. Are they symmetrical? Is there any deformity or swelling?
Is the spine straight or tilted/ curved to one side?
Observe from side
Are cervical and lumber curvatures normal?
Ask the patient to touch the toes.
Is the flexion of hip and spine normal?
(ie whether he can touch the toes)

62. From the front
TOUCH head both ways – checks lateral flexion of the neck.
Open and close the mouth – Temporo-mandibular joint.
Ask to put hands behind the head – tests gleno-humeral and sterno clavicular movements.
Ask to hold arms straight – tests elbow extension.
Ask to supinate and pronate the hands.
6.Ask to spread the fingers and show you the hands-look for any wasting, deformity or swelling (s).
7.Ask to put thumb and index finger together – checks pincergrip

63. Closely observe the lags – quadriceps bulk, any deformity or swelling.
Knee joint- any effusions by patellar tap?
Observe feel – any deformity? Any callosities?
Ask to walk around- is the gait normal? Are the amis swinging while walking?
Is the strike of heal on the ground as well as lift of toes from the ground normal?
Can he turn quickly and normally?

64. LAB . INVESTIGATION OF ARTHRITIS BLOOD INUESTIGATION RA- FACTOR
ESR
RA- FACTOR
ASOTITER
SLE

65. X-RAY REPORTS OF ARTHRITIES

66. C. T. SCAN
MRI
SYNONICAL BIOPSY
URIN TEST

67. OTHER MODE OF TAEATMENT
ALLOPATHY
Anti inflammatory
Pain killer
Relexacent
Sedatives
Local application
Hot fomentation
AYUERVEDIC
UNANI
NATUROPATHY
YOGA

68. Homeopathic Mode of Treatment
Examination : Physical and LAB Investigation
Case taking
Constitution
History : weather patient had any trauma
or accident in the past
Miasm : psora , syphilis or sycosis
Diathesis : Rheumatic or Gouty
Mental
Location : Hand , Wrist , Knee, Cervical spine
or Hip joint
Ailments (Cautions)

69. HOMEOPHATHIC REMADY
FOR
ARTHRITIS, RHEUMATISM & GOUT

70. For excessive pain before the swelling comens
           ABROTANUM
Especially for ANKLE JOINT & WRIST JOINT
For OSTEOARTHRITIS
Rheumatism:
    For excessive pain before the swelling comens  
From suddenly –checked Diarrhea or other Secretion,
Alternate with Hemorrhoids, with dysentery
Aggravation; - at night and from cold
Amelioration; - by motion

71. ACTAEA SPICATA
Special Affinity for Smaller joints
Wrist, & Fingers Ankles & toes
Rheumatism:
·  Swelling & aching in joints after a slight exercise.
·  Affected joints are swollen and in affected limbs
great weakness.
·  Right arm and right wrist are specially affected.
Pain:
Are violent tearing and drawing character
Aggravation: - At night motion and change of weather.
Wrist, & Fingers,
Ankles & toes.
Ankles & toes

72. · Patient cannot bear pain · Great fear of being touched or struck.
3)ARNICA MONTANA
Especially for Traumatic Rheumatism or Arthritis.
Rheumatism:
·        Ascending type of rheumatism.
·        Patient cannot bear pain
·        Great fear of being touched or struck.
Pain;
 in the back and limbs as if bruised or
beaten.
 cannot walk erect on account of pain in
pelvic organ.
Aggravation: At rest; when lying down: from wine
Amelioration: From contact ; Motion

73. BENGOIC ACID Urine dark brown And The urinous odor highly intensified
Especially for GOUTY ARTHRITIS
In a person who have History of
Suppressed Gonorrhea, Syphilis.
Gouty concretion arthritis
Affects all the joints, especially knee joint
Cracking on motion; Nodositis
Urine dark brown
And
The urinous odor highly intensified
Pain – tearing, stitching , in large joints,
Pain aggravates in night

74.  For Articular Rheumatism  Allumina is chronic of bryonia
 BRYONIA ALBA
 For Articular Rheumatism
 Allumina is chronic of bryonia
 Great dryness of all mucus membrane.
 Great thirst for large quantity of cold water
at long interval
Pain: Stitching, tearing, worse at night.
Aggravation: from slight motion, exertion, touch,
Suppressed discharges of any kind,
at 9 pm
Amelioration: Complete rest, lying on painful side
pressure, cold.

75. CALCAREA CARB CAULLOPHYLLUM For Gouty Nodos ties about fingers
Arthritis nodosa deformans.
Aggravation: cold air wet weather, cold water in morning.
Amelioration: Lying on painful side.
CAULLOPHYLLUM
For Arthritis Deformam in women’s.
Affinity for smaller joints.
Pain: Severe drawing, tearing pain.
Pain is of flying nature; migrate from one place to another.
Pain in fingers and wrist. Fingers are very stiff.
Aggravation: in open air and coffee
Amelioration: By emission of flatus.

76. CAUSTICUM For Rheumatoid Arthritis For Chronic Articular Rheumatism
CAUSTICUM
For Rheumatoid Arthritis
For Chronic Articular Rheumatism
Rheumatism: Of joints with stiffness and contraction
of flexor tendons,
Shortening of muscles.
Aggravation: in clear weather
Amelioration: In damp weather and by warm air.

77. CMICIFUGA (Actaea recemosa)
Articular rheumatism of lower limb.
Joints commonly affected are lumbo-sacral region
and Big Joints.
Rheumatism:
·        Good remedies for muscular rheumatism.
·        Especially affects the bellies of muscles of neck and back.
·        Joints commonly affected are those of
LUMBO-SACRAL REGION and big joints.
·        Uneasiness, restlessness, aching in the limb
with pain in lumbar and sacral region.
·        Rheumatism alternates with mental symptoms.
Aggravation:
·        from using arm in sewing , type writing, piano-playing.
·        From cold damp weather and during menses.
More severe the flow, greater the sufferings.
Amelioration: from warmth

78. COLCHICUM AUTUMNALE
Valvular Disease or pericrditis following rheumatism.
Acute Rheumatic fever.
Action more marked on Small Joints
Rheumatic pain
Of the clavicle, neck, shoulder, arms and back.
·        In the elbow joint, forearm, waist, and ligaments of the finger
Joints, and of great toes.
·        With lameness in the arm which make it impossible for the patient to
hold lightest thing.
·        Flying pain in the Hips,
·        Tearing pain in thighs and knee joints with swelling.
·        Tingling pain in Toes.
·        Pain has tendency to move from one joint to another ; from one side
to other , from below to upwards or from above to downwards.
Aggravation : From cold damp weather, by motion, during Autumn
Amelioration: from warmth, by rest, and lying down.

79. FERRUM MET ELLICUM For Neuralgic and Rheumatic Pain.
Rheumatism of LEFT SHOULDER
·      Tearing and stinging nature of pain.
·       Rhematic Pain in Deltoid muscle.
·        Violent pain in muscles and along the nerves.
Aggravation: From cold and rest
Amelioration: slowly moving

80. KALI BICHROME Pain Rheumatism · For Syphilitic Arthritis
·     Tearing sensation in the tibia, with swelling and
stiffness of joints.
·     Rheumatism alternates with gastric symptoms.
Pain
·      In small spots, which can be covered with TIP of finger.
·      WONDERING PAIN,
Aggravation: from cold and motion.

81. KALMIA LATIFOLIA For Acute Rheumatic fever. Rheumatism:-
·   Caused by chill, exposure to cold
·   Right-sided affection.
·   Sensation of numbness, coldness, weakness, in the limbs.
Pain:
WANDERING PAIN, changes place suddenly,
goes from one joint to other.
Pains are sticking darting, pressing,
shooting in the a downward direction.
Joints are hot, red, painful and swollen.
Þ   Heart complaint alternate with Rheumatism.
Aggravation: from least movement , becoming cold.
Amelioration: continued motion

82. LACHESIS Sciatica, right side, better on lying down. Pain
For Rheumatic Carditis.
Sciatica, right side, better on lying down.
Pain
In lower Extremities, in Tibia, in Neck worse cervical region
Shortening of tendons.
Neuralgia of coccyx, worse rising from sitting posture.
Sensation of threads stretched from back to arms, legs,
eyes, etc.
Aggravation: from warm bath, pressure or constriction, hot drinks
Amelioration: appearances of discharges warm application

83. LYCOPODIUM CLAVATUM Chronic Articular Arthritis Right-sided remedy
Rheumatic Pain
In ankle, and finger Joints,
Painful Callosilitis (CORNS ) on soles
All disease is worse in the afternoon from 4 to 8 pm.
Tearing in shoulder and elbow joints.
One feet hot and other is cold.
Chronic gout, with chalky deposit in joints.
Aggravation: Right side, from right to left, from above downward.
4am to 8 pm. from heat
Amelioration: by motion. After mid night

84. NATRUM MUR Symptoms are worse from sunrise to sunset,
Chronic articular Arthritis.
Based on History of Dyscrasia.
Symptoms are worse from sunrise to sunset,
especially from 10 to 11 pm.
Painful contraction of the Hamstring.
Pain in back with desire to support.
Palms hot and perspiring.
Ankles weak and turn easily.
Cracking in joints on motion.
Aggravation: from noise, music, lying down, heat, and talking.
Amelioration: open air, pressure against back. Lying on right side.

85. RHODODENDRON Fibrous deposit is great Toe-joint. Right-sided remedy.
Chronic Osteoarthritis
Gout with fibrous deposit in great toe joint.
Rheumatism:-
Chromic Rheumatism affecting the smaller joint
Acute inflammatory swelling of the joints.
Pain.
·       Drawing ,tearing pain in the limbs.
·       Sometimes wandering from one joint to other.
·       Pain in dorsal region, extending to arm, in bone and
periosteum
·       Pain in the shoulder that arm cannot be moved.
Aggravation ; During rest, before and during storm
Amelioration; By warmth, wrapping up moving.

86. Traumatic and Articular Arthritis. Rheumatism:-
RHUS- TOXICODENDRON
Right-sided remedy
For Osteoarthritis
Traumatic and Articular Arthritis.
Rheumatism:-
·     Caused by lying on damp ground, summer bathing,
working in damp place.
·     Great restlessness, anxiety and apprehension.
·     Always want to be moved, cannot remain in one place.
Pain.:
·       As if Sprained,
As if muscle or tendon were torn from its attachment.
·       As if bone were scrapped with knife.
Aggravation; - After midnight, in rainy weather,
" On first moving, and getting up in morning."
Amelioration; - By walking, and continued motion.

87. SULPHUR THUJA OCCIDENTALIS
Facilitates absorption of serous or inflammatory exudates
in pleura & joints
Acute and Chronic Rheumatism
After the attack of acute Dyscrasia
Aggravation; By standing, rest, heat, bathing, changeable weather.
Amelioration; By dry warm weather, lying on right side
THUJA OCCIDENTALIS
Gonorrheal Arthritis
Sycotic Poison, Arthritis deformens
Aggravation; At night, at 3pm and 3 am, form cold damp air . Etc…
Amelioration; In open air, by movements, pressure, rubbing

88. MANAGEMENT The concept of joint protection is vital for the
patients with OA. Especially where large
joints are involved.
Protection from overuse is important.
Assistant devices to reduce weight bearing joint pain –
ie canes.
Reduce impact exercise like jogging.
Increase non weight bearing exercise –
ie swimming / cycling. .

89. Physiotherapy will maintain joint protection through
Good quality footwear, when walking recreationally.
If any leg length discrepancy, ensure it is corrected.
Weight reduction is crucial especially in obese patients
with large joint problems on weight bearing.
Physiotherapy will maintain joint protection through
optimizing the strength of adjacent supportive
muscles.
Heat and ultrasound may relieve muscle spasm.a

90. General Measures Diet Rest - Both mental and physical
One has to avoid the following items.
Tea, Coffee, Fried things, Salt, Chilly, Spices and condiments milk and milk products. Heavy digestive Dal , Rice , Pickles Alcohol an d Non- veg diet .
Yogic therapy include
Yogasanas, Pranayama, rest and other arthritic
exercise
Rest - Both mental and physical
Exercise- morning walk, running etc.
5. Correction of Anemia
6. Avoidance of cold, dampness and draughts.
7. Removal of focal infection

91. Exercises for arthritis

96. CORRECT YOUR POSTURES
1.Correct postures of sitting, standing and walking make a difference in patients of cervical spondylitis. Wrong postures, even temporary, can result in strains on the joints and bring diseases.
There should not be any hump in the back when the child learns to sit, stand and walk

97. 3.When we sit, stand, walk or
drive a vehicle, do not bend spine
Car drivers not keeping their backs straight also get neck pains. The seat of the car should be adjusted nearer to the steering wheel and if there is space between seat back and upper hips area.
A small pillow should be placed in between.

98. Sleep, bed and pillow: Both neck and back pain have a definite bearing with the type of bed
7. Sleeping posture. Those who suffer from cervical spondylosis should try to sleep on the left or right side instead of continuous sleeping on the back. While sleeping on the sides of the body, one should lie with the legs slightly flexed or bent at the knees towards the abdomen. This offers great relaxation to the muscles

99. Standing postures during parties: In most of the parities, the fashion is to stand for a long lime at one place.

100. 13. Working on computers need more care for neck pain
13. Working on computers need more care for neck pain. The table should match your height. Roughly your elbows and table top should be at same level. Your eye level should be in alignment with screen of computer continuously for hours

101. Case:- Patient’s Name:- Mr. Bhagwan Lal Patel
Address:- Arnodh (Dist.:-Indore)
Age:- 68yrs.
Occupation:- Farmar
Date:- 14/11/08
Mobile:

102. PRESENT COMPLANTS
Pain & Swelling in both Knee & Ankle Joints (Since:- 4 Months)
Allergic Rashes on Neck & Face taking antiallergic.
Difficulty in Breathing.
Pain worse when goes to upstairs & down stairs.

103. Personal history Thermal Relation:- chilly Pt.
Thirst:- 10 to 12 glass per day.
Appetite:- decreased.
Aggravation:- when goes upstairs, down stairs & cold wet weather.
Amelioration:- warm application.
Stool:- Clear
Urine:- Scanty

104. MENTAL GENERAL
Restlessness.
Fearful
Irritable+

105. General Examination Built:- N Skin:- Rashes on Neck & Face
Toung:- Red & Cracked
B.P. 130/80 mm/hg

106. 1ST Prescreption Rx
Rhus. Tox. 200] 1 drm
T.D.S. for 7days

107. Second prescription C/o Slightly relief in pain & swelling
Rashes disappears Rx
Plc 200]1/2 dm
B.D. for 7 days

108. C/o
Pain & swelling as it is.
Sneezing & coryza. Rx
Rhus. Tox. 200]1/2 dm
B.D. for 5 days

109. C/o
Pain & Swelling worse.
relieved in coryza & sneezing.
Stiffness in neck.
Pain in both shoulder Rx
Rhododendron 200 ]1/2 drm
T.D.S. for 3 days
Plc 200 ] B.D for 5 days

110. Advise Avoid sour things, fatty food & high rich protein diet.
Do some mild exercise

111. C/o
Much relief in all complaints
mentally feel well Rx
Plc 200 ] 1 drm
B.D for 8 days

112. C/o
No further relief
Complaints are as it is Rx
Medorrhinum 1M ] 1dose
Rhus tox 200 ] 1drm
B.D. for 7 days