Sciatica गृध्रसी

1. A case paper presentation on Sciatica disease Submitted to:- Dr. Jinesh jain (H.O.D.,M.D.,PhD) Dr. Shweta Agrawal(M.D) Dr. Prashant parauha(M.D.) • Submitted by:- RATNESH KUMAR SHUKLA B.A.M.S. FINAL YEAR

2. SCIATICA

3. CASE • OPD NO. - 24051 • PATIENT NAME - SUKHLAL PRAJAPATI • AGE - 40 YR • ADDRESS - TALA, DISTRICT – REWA, MP. • SEX - MALE • RELIGION - HINDU • EDUCATION - ILLITERATE • OCCUPATION - LABOR • ECONOMIC STATUS - LOWER CLASSES • MENTAL STATUS - CONSCIOUS AND CO-OPERATIVE

4. CHIEF COMPLAINT • BACKAECHE RADIATE TO RIGHT LEG - since 2 months • DIFFICULTY IN SITTING - since 2month HISTORY OF THE PRESENT ILLNESS :- ACCORDING TO THE PATIENT HE WAS HEALTHY BEFORE 2 MONTH AFTER THAT HE WAS SUFFERING FROM GRADUALLY INCREASING PAIN WHICH RADIATE FROM HIP TO TOE AND PAIN GOT AGGRAVATED, THE WAS NOT ABLE TO SIT PROPERLY, SO HE CAME TO GOVT. AYURVEDA HOSPITAL NIPANIA REWA FOR TREATMENT. PAST HISTORY :- NO RELEVANT HISTORY

5. MEDICAL HISTORY :- ACCORDING TO THE PATIENT WHEN HE FELT GRADUALLY PAIN WHICH RADIATE FROM HIP TO TOE, HE TAKES SOME PAIN KILLERS FROM MEDICAL STORE. • PERSONAL HISTORY :- • BOWEL - CLEAR • APPETITE - NORMAL • MICTURATION - NORMAL • SLEEP - IMPROPER (DECREASE DUE TO PAIN) • ADDICTION - TOBACCO • ASHTAVIDHA PARIKSHA:- • NADI - SAMANYA • MUTRA - PEETABHA • MALA - PRAKRITA • ZIVHA - ANAVRITHA • SHABDA - SPASHTA • SPARSHA - SAMASHEETOSHNA • DRIKA - SAMANYA • AKRITI - MADHYAMA

6. GENERAL EXAMINATION :- • BLOOD PRESSURE - 110/80 mm of HG • PULSE - 75 /MIN. • TEMPERATURE - NORMAL • STRAIGHT LEG RAISING TEST :- ON RIGHT LEG - +VE IN 45° • ON LEFT LEG - -VE at 90° • LASEGUE TEST - +VE IN RIGHT LEG • PHYSICAL EXAMINATION :- • GENERAL APPEARANCE – NORMAL • GAIT - PROPER • LOCAL EXAMINATION :- • INFLAMMATION - ABSENT • TENDERNESS - PRESENT • *** Provisional Diagnosis – sciatica (ON THE BASIS OF CLINICAL EXAMINATION)

8. SCIATIC NERVE • SCIATIC NERVE IS THE THICKEST NERVE IN THE BODY. • IN ITS UPPER PART, IT FORMS A BAND ABOUT 2CM WIDE. • IT BEGINS IN THE PELVIS AND TERMINATES AT SUPERIOR ANGLE OF POPLITEAL FOSSA BY DIVIDING IN TO THE TIBIAL AND COMMON PERONEAL (FIBULAR NERVE). • It contains fibers from both the anterior and posterior divisions of the lumbosacral plexus.

9. ORIGIN AND ITS ROUTE • THIS IS THE LARGEST BRANCH OF SACRAL PLEXUS. • ITS ROOT VALUE IS L4, L5, S1, S2, S3. • IT IS MADE UP OF TWO PARTS, THE TIBIAL PART AND THE COMMON PERONEAL PART. • THE TIBIAL PART IS FORMED BY THE VENTRAL DIVISIONS OF THE ANTERIOR PRIMARY RAMI OF THE L4, L5, S1, S2, S3. • THE COMMON PERONEAL PART IS FORMED BY THE DORSAL DIVISIONS OF THE ANTERIOR PRIMARY RAMI OF L4 , L5, S1, S2.

10. Supply of Individuals nerve root

11. SCIATICA • DEFINITION - lt is a term used to describe the symptoms of low back pain that spread s through the hip, to the back of thigh and down the inside of the leg via the sciatic nerve, characterized by pain, tingling numbness, or weaknesS. • Sciatica sometimes known as raticulopathy is a description of symptoms of inflammation or compression of the sciatic nerve, not a diagnosis .A herniated disc, spinal stenosis, degenerative disc disease, and Spondylolisthesis can all cause sciatica.

12. CAUSES 1.True sciatic neuritis -polyarteritis nodosa , nerve injury due to injection or trauma ,post herpetic neuralgia. 2. Mechanical pressure on nerve or roots or referred pain • In the spinal cord-tumours of cauda equina, arachnoiditis, rarely thrombosis, haemorrhage or infection irritating meninges of the cord. • >In the cord space-protruded intervertebral disc, extra medullary tumours. • >in the vertebral column -Arthritis tuberculosis, spondylolithesis, ankylosing spondylitis, primary bone tumours , secondary carcinoma. • >In the back- Fibrositis of posterior sacral ligaments, compression where the nerve leave the pelvis in those who lie immobile on a hard surface for long time.

13. Cause • In the thigh and buttock- fibrositis sacro-sciatic band, hip joint or sacro-illiac joint disease neurofibroma, haemorrhage within or adjacent to nerve sheath in blood dyscrasia and anticoagulant therapy, misplaced therapeutic injuction. • >In the pelvis- sacroiliac arthritis or stain, hip disease , infection of prostate or female genital ract rectal impactions, tumors of lumbo sacral plexus.

14. Description of major causes

15. Description of the major causes

16. Description of the major causes

17. Non spinal major causes

18. Symptoms • Cramping sensation in thigh. • Radiating pain from the buttock down back of the leg. • Tingling in the legs. • Numbness in the legs. • Burning sensation in the legs or thigh area. • Severe causes present with muscle weakness. • Most often the symptoms are seen only on one side. • lf the symptoms are present on both sides the discs bulge is usually more severe. • Most often the symptoms are continuous.

19. Special sign • SLR test- restriction of straight leg raising is usually much more marked in lesions affecting the nerve roots then in purely skeletal affection . SLR test gives a useful indication of the severity of the sciatica and increased capacity for painless SLR is objective measure of improvement. • The straight leg raise, also called Lasègue's sign, Lasègue test or Lazarević's sign, is a test done during a physical examination to determine whether a patient with low back pain has an underlying herniated disc, often located at L5. • Popliteal compression- radiating pain can often be aggravated by pressure over the course of the tibial nerve through the popliteal fossa it is an traditional finding in favor of root comparison. • Testing of the sacroiliac joints- by pressure on the two anterior superior iliac spine. Estimation of range and painless or otherwise ofl hip joint by passive stretching. Muscle power in the lower limb tested against resistance.

21. Knee & ankle jerks-when L4 roots is involved kncc jerk is depressed and there is likely weakness of tibialis anterior muscle. S1 root ankle jerk lost and weakness, when present involves the calf muscles.

22. INVESTIGATION • Imaging of spine – • Straight X-rays- for detecting disc narrowing in lumbar spine, or lesion of sacroiliac or hip joint. • MRI of lumbo-sacral spine. • CSF —may show increased protein with normal cell count in large protruded inter-vertrebral disc. • Procaine inJection test- for diagnosis of fibrositic pain; contact with needle aggravates local pain and elicits refered pain; procaine suppresses both, and freedom of leg and spine movement is restored.

23. Management • Symptomatic treatment of sciatica: • Acute stage- • Rest in bed with boards under the mattress to support the back. • Analgesies as required. • Heat • Injection of 2% procaine or of lignocaine into the sciatica nerve or epidural space or tender spots in the sacroiliac region may give dramatic relief • 2. Chronic stage- management for underlying causes.

24. Conservative management • High grade sciatica- • Injection of tender spots with 5% procaine • Counter irritation, heat and massage • Epidural injection 10 ml of 2% novocaine, followed by 80 to 100 ml, of normal saline; repeated once a week. • Many patients with sciatical due to extra-dural adhesions may be benefited by injection of 30 ml 1% procaine hydrochloride mixed with 125 mg. • Hydrocortisone injected into the epidural space . three injections ard given on consecutive or alternate days. • This should be followed by active and passive excercises carries out to limit of tolerance. • Low grade sciatica- stretching of sciatica nerve, and injection of novocaine into, or as possible to the sheath of the nerve.

41. Line of treatment • Date – 04/12/2019 . Opd/Ipd – 24051/1197 • Diagnosis – sciatica • बाह्य प्रयोगार्थ • अभ्यंग - महानारायन तैल • स्वेदन - पत्रपिंडस्वेद • नाड़ी स्वेद • अभ्यांतर प्रायोगार्थ • रास्नदी गुग्गुल। २ * ३ • महा रास्नादी क्वाथ। ३०ml (१*२) • चूर्ण- • अश्वगंधा। -३gm • महा वाता वि ध्वनशक रस-१२५mg • एकांगवीर र स -१२५mg १ * २ अग्नितुंडी वटी। - १*२

42. Treatment plan • Date • 04/12 to 10/12 • 10/12 to 16/12 • Treatment and outcomes • Nadi Seka and patrapinda Seka have done everyday along with all shamana aushadh,SLR +ve at 45° to 50°,No marked relief,pain aggrevated at night and sitting position • Matra basti 50ml of mahanarayana taila started regularly,At night dashanga lepa applied and covered by erandapatra helpful for night pain from second day of use,after 6days SLR test +ve at 50°- 55°,pain during sitting position remain persist shamana aushadha continue

43. Treatment • 17/12 to 25/12 • Planned for yoga basti (1anuvasana+3Niruha(dashamoola kwatha)+3anuvasana+1anuvasana), successfully done,patrapinda was stopped during yoga basti • during the yoga basti patient got relief in all symptoms like pain and weakness • At 25/12 IN SLR test +Ve at 80° - 85° • No marked pain during sitting or night time • Patient feel good and got discharged By 26/12 from ipd , • Respected mam had prescribed Some shamana aushadha and give proper indication of pathya and apathya

44. Conclusion • Total number of days treatment given – 22 days • On giving 22 days treatment to patient their was 80% relief to the patient by T/t given with the Positive changes in symptoms . • The changes in SLR test From 45°to 85° total 40°changes of relief was found as per the T/t given tobthe patient. • This shows how Ayurveda line of treatment is helpfull in treating patient of sciatica disease or गृध्रसी

45. Reference • चरकसंहिता • सुश्रुत संहिता • चक्रदत्त • भावप्रकाश • योगरतनाकर • माधव निदान • API Book of medicine • Clinical pathology by Dr p.j.mehta • Www.wekepedia.com • www.osmosis.org