management Ligament tear(knee) ayurveda.pptx

it is a ppt made on ligament tear combining modern and ayurveda concepts of disease but more importantly focusing on ayurvedic management.it is well researched ppt including my own views regarding doshas and treatment involved.

1. Made by Aparna Kumari (2019-20) Guide-Dr. Pranav Sir MANAGEMENT OF L IGAMENT TEAR (KNEE ) PANCHKARMA DEPARTMENT

2. Content Anatomy Causes Types and Grade of tears Symptoms Diagnosis Knee examination tests Ayurveda correlation Samanya chikitsa Case study

3. Definition Also known as ligament rupture or sprain, involves damage to the tough,fibrous tissues that connect bones to each other at a joint. Ligament -band or sheet of strong fibrous connective tissue that connects the articular ends of bones, binding them together to limit motion, or a thickened portion of peritoneum or mesentery supporting a visceral organ. Function- joint stability guide joint motion prevent excessive joint movement

4. Some major ones Knee Shoulder Ankle

5. Causes and Risk Factors Acute Injuries Sudden impacts and falls that can cause ligament tears. Chronic Overuse Repetitive stress and poor technique leading to injuries. Sports-Related High-impact sports with increased risk of ligament injuries.

6. Types and Grades of Tears Grade 1 (Mild) Stretching, minor damage (0-10% fiber disruption). Symptoms: Pain, mild swelling, no instability. Joint function is largely unaffected, and weight-bearing is typically possible with minimal discomfort. Grade 2 (Moderate) Partial tear (10-99% fiber disruption). Symptoms: Pain, swelling, some instability. Weight-bearing may be difficult, and there is a noticeable compromise in joint stability during movement. Grade 3 (Severe) Complete rupture (100% fiber disruption). Symptoms: Severe pain, significant instability, loss of function. The joint is unable to bear weight and may buckle or give way during any attempt at movement. Palpable gap may be present.

7. Symptoms Pain Varying levels of discomfort. Swelling Inflammation around the joint. Bruising Discoloration from bleeding. Instability Feeling of the joint giving way.

8. diagnosis History Examination Xray (to rule out fracture) MRI

9. Ligament specific tests(knee) Anterior cruciate ligament 1.Lachman test Knee flexed and the examiner attempts to move tibia forward on femur + ve -excessive forward movement 2.Anterior drawer test Knee flexed at 90 degrees and examiner pulls the tibia forward +ve-excessive forward movement

10. Posterior cruciate ligament 1.Posterior drawer test Knee flexed at 90 degrees and examiner pulls the tibia backward + ve -excessive backward movement 2.Posterior sag test With the patient lying supine and the knees flexed to 90 degrees the tibia of a pcl injured knee will appear to sag backwards compared to the uninjured knee.

11. Medial collateral ligament Valgus stress test The examiner applies a force to the outside of the knee, pushing it inward. This test is performed with the knee in both full extension and in 30 degrees of flexion. Increased laxity suggests an mcl injury.

12. Lateral collateral ligament 1.Varus stress test Force is applied to the inside of the knee to assess the stability of the lcl . + ve test-Excessive outward movement

13. Ayurvedic corelation स्नायु गत वात अस्थि आवृत वात शोफ वातवृद्ध व श्लेष्मक्षय

14. पूर्वरूप In vaat vyadhi acharyas has mentioned avayakta lakshan as purvroop Snayugat vaat and asthi aavrit vaat purvroop have not been mentioned separately In aaghat janya shopha or in aaghat janya vyadhi first there symptoms then doshas get vitiated.

15. स्नायुगत वात स्नायुप्राप्तः स्तम्भकम्पौ शूलमाक्षेपणं (सु.नि.1) बाह्याभ्यन्तरमायामं खल्लिं कुब्जत्वमेव च| सर्वाङ्गैकाङ्गरोगांश्च कुर्यात् स्नायुगतोऽनिलः || ( च.चि.28) चिकित्सा-स्नेह उपनाह अग्निकर्म बन्धन मर्दन

16. अस्थि आवृत वात स्पर्शमस्थ्नाऽऽवृते तूष्णं पीडनं चाभिनन्दति | सम्भज्यते सीदति च सूचीभिरिव तुद्यते |(च.चि.28) चिकित्सा- बाह्याभ्यन्तरतः स्नेह(च.चि.28

17. आगन्तुज शोफ The inflammatory phase of ligament tear can be compared with aagantuj shoph Aagantuj shoph has symptoms similar to that of raktaj and pittaj as stated by acharya Sushrut in aampakwaseshniya(17) adhyaya of sutrasthan Symptoms- पित्तज - पीतो मृदुः सरक्तो वा शीघ्रानुसार्योषादयश्चात्र वेदनाविशेषा भवन्ति रक्तज - पित्तवच्छोणितजोऽतिकृष्णश्च

18. वातवृद्धौ श्लेष्मक्षये Ligament tear due to repetitive stress and overuse can be corelated with this. Although Vaat vridhi and kaph kshya lakshan are not mentioned simultaneously( Yugpat vridhi kshaya) but acharya charak has said दोषाः प्रवृद्धाः स्वं लिङ्गं दर्शयन्ति यथाबलम् | क्षीणा जहति लिङ्गं स्वं , समाः स्वं कर्म कुवेते ||(च.सू.17) वातवृद्धौ - वाक्पारुष्यं कार्श्यं कार्ष्ण्यं गात्रस्फुरणमुष्णकामि(म)ता निद्रानाशोऽल्पबलत्वं गाढवर्चस्त्वं च; श्लेष्मक्षये - रूक्षताऽन्तर्दाह आमाशयेतरश्लेष्माशयशून्यता सन्धिशैथिल्यं (तृष्णा दौर्बल्यं प्रजागरणं) च

19. Explanation

20. Acute/Inflammatory phase (Vrana shopha stage) Internal medicine External medicine duration Rasnasaptaka kashaya Yogaraja Guggulu Dasamoola Kashaya Dhara Lepana with Nagaradi choornam Bandana with Murivenna oil 3 – 7 days/ until swelling subside (If swelling is not present, directly stage 2 can be initiated) Bandhana refers to unique bandaging techniques that immobilizes the joint and thereby promotes the healing process.

21. The treatment procedure of “ dhara ” represents the rhythmic and systematic pouring of medicaments over specific body parts or the entire body surface for a stipulated time. Lepana refers to local application of medicated pastes. Application of paste or the lepa is the first and foremost treatment for inflammation.

22. Post Inflammatory phase (Vrana stage/ Bhagna stage/ Vatahara stage) Internal medicine External medicine duration Dhanvantaram Kashaya Gandha thylam LT bandana Abhyanga with Dhanvantaram oil Janu Dhara with Dhanvantaram oil Matra Basti with Dhanvantaram Mezhupakam oil 7days Taila Dhara is appropriate where inflammatory signs are minimal, i.e., in a degenerative phase.

23. “Abhyanga” refers to specific massaging techniques with medicated oils. After the acute/inflammatory phase, abhyanga is specifically indicated in fractures and other joint pathologies. LT Bandhan-possess anti-inflammatory, analgesic, antioxidant, tissue regeneration and joint strengthening properties

24. Matra- basti is the trans-rectal administration of medicaments especially medicated oils, in predetermined doses. It is expected to reduce the symptoms of pain and stiffness and it also strengthens musculoskeletal systems.

25. Final stage ( Vatahara / Bhruhmana stage) Internal medicine External medicine duration Dhanvantaram Kashaya Gandha thylam Annalepanam LT bandana 7 days Annalepa refers to application of a paste prepared out of cooked ‘ njavara ( shasti shaali )medicinal rice variety, over specific body parts. to nourish the joint enhance joint stability delay the onset of post traumatic osteoarthritis

26. Follow up stage (rehabilitative phase) Internal medicine External medicine duration Dhanvantaram Kashaya Gandha thylam LT bandana Quadriceps exercises Diet rich in calcium, Vit.D, Zinc and magnesium LT bandana is to be done daily for 1month, every alternative days for 2 months, weekly twice for next two months and weekly once in the last month. No.2 & 3 is advised for 6 months

27. A 22yr old female with complaints of pain, occasional swelling and painful flexion of the right knee joint for 2 years. History of present illness that patient was apparently normal 2yrs ago. One day while practicing some sport activity patient had a fall on outstretched right knee. Since then, patient had severe pain which was associated with swelling and restricted movements. Pain aggravated on strain. So, for the same patient consulted some orthopedic surgeon and he prescribed some analgesics and advised with some exercises. Later after one year again patient started getting the similar kind of pain and associated swelling occasionally and was advised for surgery for the same. So, to avoid surgery patient got admitted in GAMC Bengaluru.

28. General examination Knee examination Built - Medium Restriction of movement of knee joint Pallor - Absent Anterior drawer test : + Temperature - 98.4°F Lachmann’s test : + Pulse rate - 70/min Pain : Diffuse Weight - 72kg Tenderness : present BP - 110/70 mm hg Crepitus : Present Respiratory Rate - 16/mins Gait : Limping Investigations done : MRI Impression : Complete tear of anterior cruciate ligament, Mild synovial effusion in the knee joint. Internal medicine External medicine Rasnaerandadi Kashaya: 60 ml BD B/M Lakshadi Guggulu : 2-0-2 with Kashaya Goksuradi Guggulu : 1-0-1 A/M Abhyanga with Murivenna for 7 days Visha Garbha Taila Pichu for 7 days Haridra Pottali Pinda Sweda for 7 days

29. Result

30. Discussion Mostly the medicines used in ligament tear in the inflammatory phase are the one having properties of shothghan and shoolhar . And in post inflammatory or rehabilitative phase are the one which will give poshan to the joints and will supply nutrition. The formulations mentioned in bhagna , vaata vyadhi , and the one having vaat har and brihamana properties have been used. The dravyas used in pottali nirman or as medicnes or ekal Dravya are mostly sandhaniya balya and jivaniya gan aushadhi The treatment protocol is same as the one mentioned in vaat vyadhi mans gat and asthi gat disease like panchtikta ksheer basti matra basti etc has been used. Oil has mostly been used post inflammatory phase but some have even mentioned oil in the inflammatory phase stating murivenna oil to have anti-inflammatory properties. Acharya Sushrut has also mentioned Agni karma in snayugat vaat but couldn’t find any article stating evidence for the same.

31. Thank you