Locomotor System Study Guide

Study Material
[Trial Version]
Human Locomotor SyStem
Sources :
Hutchison's Clinical Methods
Online Medical Journals
Materia Medica by :Dr.T.F.Allen
William Boricke
Clarke.J.H
Cowperthwate
Farrington E A
Hering C
Kent.J.T
ICD 10 By: WHO
Compiled By;
Dr.Sreekumar.M.B
BHMS
Mob:9447084496
Contents
1,Examination of Locomotor System-3-23
2,Imaging Form -23 +
3,ICD 10 -Locomotor diseases -25 +
4,Diseases of Bones-25-26
5,Repertory of Osteopathies-27
6,Materia Medica of Bones-28-30
7,Diseases of Joints-31-35
8,Repertory of Arthropathies -36
9,Meteria Medica Of Arthropathy-37-43
10,Joint Affinity Diagram-43+
11,Soft Tissue Affections-44-50
12,Accessory and supportive Care-51-54
13,Pathology of Musculoskeletal system -55
15,Homoeopathic Anti-inflammatory Medicines -56+
Performa-Locomotor-56+
Dear Doctors,
This is a collection of clinical and therapeutic information collected from various

sources for the purpose of equipping Homoeopathic practitioners in successfully using onetenth of our remedy resources effective in the treatment of locomotor diseases. Modern
accessory and supportive care methods practiced in modern health scenario, apt to be
integrated to our system, are also been detailed. The intention of this compilation is to make
some primary steps in establishing an independent and complete orthopedic wing in
Homoeopathic System of Medicine.
Origin of the symptom
Bone
Cartilages
Joint
Muscle
Ligaments
Tendons
Bursa
Membranes
Referred
History
How the problem started?
Injuries, overstrain ete..
Difficulty in Activities of Daily
Living[Dressing,bathing,toilet,Walking]
Common symptoms of joint
Pain
Stiffness
Numbness
Swelling
Nodosities
Cracking
Joint Locking
Crepitation
Sprain
Injury
Dislocation
Exostosis
Mechanical Joint Diseases Features

o Pain on activity
o Pain improves with rest
3
o Feeling of inactivity stiffness on long rest and disappears suddenly on activity

o Clicking sensation in joint
o Joint locking especially in knee[Menisci, cartilaginous lose body in joint space]
Inflammatory Joint diseases Features

o Early morning stiffness[Persisting more than 30 minutes-a/c Inflammation]
o Redness, warmth, tenderness
o If fever or sweating most probably infection may be present[Mono articular]
Differentiating points
Activity- Pain relation
Morning Stiffness
Look and feel of joint
Which joints affected
Systemic involvement
Distribution
o Joint:Diffuse pain and tenderness,swelling,restricted movement
o Bone:Deep seated and localized pain usually
o Tendon:Local pain tenderness at attchment,tendon sheath swelling,resisted
movement painful.
o Ligament:Localized pain and tenderness in attachment or ligament,Pain on
streach
o Bursa:localized tenderness
o Muscle:Localized or diffuse pain, pain on resisted action and stretch
Reccurnce
o Episodic
o Flitting; Beginning in one joint and serially involving other joints[Gonococcal
arthritis]Skin lesions and urethritis may seen
General observations
o
o
o
o
o
o
o
Gait
Posture
Mobility
Deformity
Independence
Muscle wasting
fractures
Examination of bones
Inspection
o
o
o
o
o
Alteration in shape or outline, shortening

Bowing of long bones[Pagets disease]
Epiphyseal enlargement[Rickets]
Osteochondral enlargement[Rickety rosary]
Localized swelling of bones due to cysts, infections or tumors
4
o Spontaneous fracture-Secondary carcinoma, multiple myeloma,

hyperparathyroidism
Palpation
o Tenderness seen in local lesions with periosteal diseases
o Fractures
Examination of Joints
Inspection
o
o
o
o
Range of movement[Compare with corresponding side]

Swelling, deformity, tenderness ,warmth,
Symmetrical [Rheumatoid arthritis]
Asymmetrical[Psoriatic arthropathy or gout]
Palpation
o Tenderness: severe tenderness and cannot touched [Grade 4]is a feature of septic
arthritis, crystal arthritis and rheumatic fever
o Bony enlargement[Herberdens nodes],thickening of synovial tissue, joint
effusions,
o Tenderness and enlargement of end radius and ulna[Hypertrophic pulmonary
osteoarthropathy]
o Joint crepitus: Detected by feeling the joint while moving joint[Osteoarthritis or
loose bodies]
Spine
Vertebral Column
Cervical spine: 7 vertebrae (C1C7)
Thoracic spine: 12 vertebrae (T1T12)
Lumbar spine: 5 vertebrae (L1L5)
Sacrum: 5 (fused) vertebrae (S1S5)
Coccyx: 4 (35) (fused) vertebrae (Tail
bone)
Total -33
Over view of Spine
The low back is formed by 5 lumbar

vertebrae and the sacrum.
The bones are covered by periosteum,
which is innervated and thus generates
pain if inflamed
The vertebrae are separated by discs,
which allow for smooth, cushioned
articulation.
The outer aspect of the disc is made of a
tough fibrous tissue called the annulus
fibrosis, while the inner aspect is
gelatinous and known as the nucleus
propulsus.
Powerful ligaments connect the
verterbrae to each other
The vertebral column has regularly spaced
lateral openings known as neuroforamina,
through which nerve roots exit
The actual cord ends at about the L1 level.
Below this point, nerve roots (known as
the cauda equine) drape down and fill the
Common Benign pain syndromes

of back
Non-specific
pain:
musculoskeletal
This is the most common cause of back pain. Patients present with lumbar
area pain that does not radiate, is worse with activity, and improves with rest.
There may or may not be a clear history of antecedent over use or increased
activity. The pain is presumably caused by irritation of the Para-spinal muscles,
ligaments or vertebral body articulations. However, a precise etiology is
difficulty to identify.
7
Specific problems in back
Major Symptoms:
Often referred to as "sciatica," this is a pain syndrome caused by irritation

of one of the nerve roots as it exits the spinal column.
The root can become inflamed as a result of a compromised
neuroforamina (e.g. bony osteophyte that limits size of the opening) or a
herniated disc (the fibrosis tears, allowing the propulsus to squeeze out and push
on the adjacent root
Burning or electric shock type pain that starts in the low back, traveling
down the buttocks and along the back of the leg, radiating below the knee. The
most commonly affected nerve roots are L5 and S1.
Examination Keys: Spine
Examination shall be conducted in erect posture

Observe gait. Is it slow, limited by pain?
Any skin abnormalities suggesting underlying inflammation
Normal Curvature: Cervical spine sweeps anteriorly, thoracic spine sweeps posteriorly,
and lumbro-sacral spine sweeps anteriorly.
Range of motion testing should include forward flexion, hyperextension, lateral flexion,
and rotation
Pain along Vertebral Colomn?
Para-spinal pain- spasm of muscles
Palpate the spine. Processes that inflame the bone (e.g. compression fracture,
osteomyelitis, metastatic disease) will generate pain when the affected vertebrae is
palpated or percussed.
In the kidney infection (pyelonephritis), percussion over this area will cause pain
Abnormal Curve
Prominent Vertebral Projections [C7 normal]
Parasthesia of arm from neck movement [Nerve
involvement]
Angular deformities
Painful restriction of movement [Spodylosis,Disc
complaints]
Chest Expansion [Reduced in Ankylosing spondilitis]
Pain and limitation SLR [Prolapsed intervertebral disc with
irritation of sciatic nerve
SLR Test
Cup the heel of their foot and gently raise the leg. If there is nerve
root irritation, the patient will experience their typical pain when the
leg is elevated between 30 and 60 degrees. This is referred as the
straight leg raise test and is sensitive for identifying root pathology
(i.e. if it does not reproduce pain, root irritation unlikely). Sensitive (7590%), but not specific. Therefore, negative test helps rule out nerve
9
root irritation as cause of pain. . If the straight leg test is positive,

repeat the same test on the opposite leg. This is called the crossed
straight leg raised test and is 85-95% specific for root irritation, but not
sensitive. Therefore, positive test makes root irritation the likely
etiology of the symptoms
.
Shoulder
Shoulder Construction
The shoulder joint is created by the confluence of 3 bony

structures: the scapula, humerus and clavicle. These are
held together by ligaments and an intricate web of muscles.
Critical external landmarks include the following:
Acromion
Clavicle
Scapula
Deltoid muscle
Supraspinatus
10
Infraspinatus
Teres Minor
Active ROM [Range of Movement]

Abduction: Determine the extent to which the patient can
abduct their arm. The patient should be able to lift their
arm in a smooth, painless arc to a position with hand above
their head. Normal range is from 0 to 180 degrees
Adduction and Internal rotation Ask the patient to place

their hand behind their back, and instruct them to reach as
high up their spine as possible. Note the extent of their
reach in relation to the scapula or thoracic spine. They
should be able to reach the lower border of the scapula
Forward flexion: Ask the patient to trace out an arc while

reaching forward (elbow straight). They should be able to
11
move their hand to a position over their head. Normal range is

0 to 180 degrees.
Extension:
Ask the patient to reverse direction and trace an arc
backwards (elbow straight). They should be able to
position their hand behind their back.
Passive ROM[Range of Movement]
If there is pain with active ROM, assess the same

movements with passive ROM. Have the patient relax and
place one of your hands on their shoulder. Gently grasp the
humerus in your other hand and move the shoulder through
the range of motions described above. Note if there is pain,
and if so which movement(s) precipitates it. Also note if you
feel crepitus with the hand resting on the shoulder.
Findings
Pain/limitation on active ROM but not present with

passive ROM suggests a structural problem with the
muscles/tendons, as they are firing with active ROM but
not passive.
Crepitus suggests Degenerative Joint Disease
12
Impingement-common cause of shoulder pain
Impingement:[To encroch] lead to tendonitis and bursitis.

Shoulder pain in general is very common, with impingement as the
root cause in a large number of cases. The 4 tendons of the rotator
cuff all pass underneath the acromion en route to their insertions
on the humerus. The space between the acromion/coracoacromial
ligament and the tendons (in particular, the supraspinatus) can
become relatively narrowed for any number of reasons (e.g. the
growth of an oteophyte on the under surface of the bone). This
causes the tendons to become impinged upon. The resulting
friction inflames the tendons as well as the subacromial bursa,
which lies between the tendons and the acromion. The net result is
shoulder pain, particularly when raising the arm over head (e.g
reaching for something on a top shelf, arm positioning during
sleep. Chronic irritation to the tendons can lead to fraying, tears,
and even complete disruption
Sub-acromial Palpation
First, identify the acromium by walking your fingers along the
spine of the scapula until you reach its lateral endpoint, which is
the acromium. Then gently palpate in the region of the subacromial space. Palpation may cause pain if the tendons/bursa
are inflamed.
Limitations of clinical examination

Defining the precise location of the problem (ie. bursitis, tendonitis
or even partial rotator cuff tears) of shoulder joint can be difficult
13
to make on clinical grounds .So MRI is an extremely helpful tool

in defining the precise nature of the pathology.
Elbow, Wrist, Finger joints
Common Problems[Elbow]
Medial Epicondylitis (golfers elbow): Presentation:
Flexors and pronators of the wrist insert on the medial
epicondyle. Repetitive flexion of the wrist can cause
inflammation and pain around this bony prominence.
Examination is usually remarkable for:
Pain on palpation around the medial epicondyle.
Reproducibility of pain with resisted wrist flexion.
Absence of warmth, erythema, or other findings of
acute inflammation.
Lateral Epicondylitis (tenniselbow): Presentation and

Anatomy: Extensors and supinators of the wrist insert on
the lateral epicondyle of the humerus. Repetitive
extension (e.g. back hand motion in tennis, though could
be any activity with similar movement) of the wrist can
cause inflammation and pain around this bony
prominence. Examination is usually remarkable for:
Pain on palpation around the lateral epicondyle.
14
Reproducibility of pain with resisted wrist extension

and supination.
Absence of warmth, erythema, or other findings of
acute inflammation.
Arthritis
Olecranon Bursitis : The olecranon process is formed by the

proximal aspect of the Ulna and is the bony prominence that
forms the tip of the elbow. The olecranon bursa is a fluid filled
pouch that is located directly on top of the olecranon process.
It provides a lubricating pad that minimizes direct trauma to
the underlying bone during usual activity. Normally, the bursa
is not apparent on examination.
Wrist, Fingers
Common Problems[Wrist,fingers]
Carpal Tunnel Syndrome(Calc-p., Guaj., Viol-o,Causticum)

Presentation and Anatomy: The median nerve travels
through a narrow space when it crosses the wrist en route to
the hand. Occasionally, this space becomes inadequate to
accommodate the nerve, placing it under increased pressure.
The precise reason why this occurs is not clear. Patients usually
report some combination of the following:
Numbness and tingling (ie neuropathic pain symptoms) in
the distribution of the median nerve (thumb, index, middle and
lateral 1/2 of ring finger)In advanced carpal tunnel, there may
be atrophy of the thenar eminence (due to denervation of the
muscle as well as disuse atrophy) and associated decrease in
motor strength
15
Ganglion Cyst
Presentation: Idiopathic, spontaneous
protrusion of joint fluid outside of the
articular space. The cyst is painless and
usually located on the dorsal aspect of the
wrist.
Dupuytrens Contracture : Thickening of
the palmar fascia, which is usually painless
and develops slowly over time. If pronounced,
it may prevent the hand from being able to
fully open (Nat-p., Plb., Guaj., Lyc.,
Ruta,Causticum).
Heberdens Nodes: Bony excresences
that cause deformity at the DIP joints of the
fingers. Occurs slowly over time and is
associated with Osteoarthritis
Tenosynovitis
ofthe Thumb:Repetitive
abduction and
adduction of the thumb
can irritate the
tendons of the extensor
policis
brevis
and abductor policis
longus muscles.
When this occurs, any
movement of the thumb (in particular, gripping) may cause
pain at its base.
16
Knee
Watch the patient walk. Do they limp or appear to be in pain? When

standing, is there evidence of bowing (varus) or knock-kneed (valgus)
deformity? There is a predilection for degenerative joint disease to affect the
medical aspect of the knee, a common cause of bowing.
Varus Deformity
Waisting
Is there evidence of atrophy of the quadriceps, hamstring,
or calf muscle groups? Knee problems/pain can limit the use of
the affected leg, leading to wasting of the muscles
External anatomy, noting structures above and below the

knee itself:
17
Patella
Patellar tendon
Quadriceps/Hamstring/Calf muscles
Medial and lateral joint lines.
Femur and Tibia
Tibial tuberosity
Findings
Place one hand on the patella. Note any warmth, which if present,
would suggest inflammation.
crackling/grinding sensation that occurs with movement. If
present, its suggestive, but not diagnostic, of DJD
DJD is suggested by the presence of pain with activity that gets
progressively more limiting over time. Degenerative joint disease (DJD)
many patients report noises (e.g., creaking, popping, cracking)
associated with joint movement. The vast majority of these sounds are
not clinically significant. Rather, pain or functional limitation are the
subjective complaints which carry clinical relevance.
An effusion is the accumulation of fluid within the joint space. If
there is a large collection, the knee will look swollen. Lesser amounts of
fluid can be a bit more subtle.
18
Joint Line Tenderness:
Have the patient slightly flex their knee. The knee is slightly
flexed when performing all of the functional tests that are
described below. This positions the joint such that other
stabilizing elements do not interfere with the structure that
is being tested.
Define the joint space along its lateral and medial margins.
The joint line is perpendicular to the long axis of the tibia.
Gently palpate along first the medial and then the lateral
margins. Pain suggests that the underlying meniscus is
damaged. Osteoarthritis can also cause joint line tenderness
Ligaments
The ligaments are very strong tissues that
connect bone to bone. In the knee, they assure
stability and correct alignment. There are 4 main
ligaments in the knee: Medial collateral (MCL),
lateral collateral (LCL), anterior cruciate (ACL) and
posterior cruciate (PCL)..
Following a ligamentous injury, there is generally acute pain, swelling
and the injured person will often report hearing a pop (the sound of the
ligament tearing).
After the acute swelling and pain have dissipated, the patient may
report pain and instability (sensation of the knee giving out) during any
maneuver that would expose the deficiency created by the damaged
ligament
19
Bursitis
Pre-patella: Located directly on top of
the patella. Most frequently affected due
to direct trauma, as may occur with
people who spend a lot of time on their
knees (e.g. carpet layers, carpenters).
Infrapatella : Below the knee. Also

affected by direct trauma, as with the
prepatellar bursa.
Hip
Inspection
Inspection done while the patient is standing

Look Front and back of pelvis/hips and legs and comment on
20
Ischaemic or trophic changes

Level of ASIS (anterior superior iliac spine)
Swelling (soft tissue, bony swellings)
Scars (old injuries,previous surgery)
Sinuses (infection, neuropathic ulcers)
Wasting (old polio, Carcot-Marie-Tooth) or hypertrophy
(e.g. calf pseudo-hypertrophyin muscular dystrophy)
Deformity (leg length discrepancy, pes cavus, scoliosis,
lordosis, khyphosis)
Palpate
Any swellingsAnteriorly in scarpas triangle, Trochanteric
region or gluteal region
Pelvic tilt by palpating level of ASIS (anterior superior illiac
spine)
Move
Gait: Observe
Smooth and progression of phases of gait cycle
Comment on stance, toe-off, swing heel strike, stride and
step length
Sufficient flexion/extension at hip/knee ankle and foot:
Any fixed contractures?
Arm-swing and balance on turning around
Abnormal Gait Patterns
Trendelenburg (pelvic sway/tilt, aka waddling gait if
bilateral)
Broad-based (ataxia)
High-stepping (loss of proprioception/drop foot)
Antalgic (mention with reduced stance phase on left/right
side)
In-toeing (persistent femoral anteversion)
21
Inspection done while supine[edit]
The hip should be examined for:

Masses
Scars
Lesions
Signs of trauma/previous surgery
Bony alignment (rotation, leg length)
Muscle bulk and symmetry at the hip and knee
Measures
True leg length - Greater Trochanter of the femur or Anterior
Superior Iliac Spine of pelvis to medial malleolus of ipsilateral
leg.
Apparent leg length - umbilicus or xiphisternum (noting which is
used) to the medial malleolus of ipsilateral leg.
In hip fractures the affected leg is often shortened and externally
rotated.
Palpation
The hip joint lies deep inside the body and cannot normally be
directly palpated.
Trendelenburg test/sign:
1. Make sure pelvis is horizontal by palpating ASIS.
2. Ask patient to stand on one leg and then on the other.
3. Assess any pelvic tilt by keeping an index finger on each ASIS.
4. Normal (Trendelenburg negative): In the one-legged stance, the unsupported
side of the pelvis remains at the same level as the side the patient is standing or
even rise a little, because of powerful contraction of hip abductors on the stance
leg.
5. Abnormal (Trendelenburg positive): In the one-legged stance, the unsupported
side of the pelvis drops below the level as the side the patient isstanding on.
This is because of (abnormal) weakness of hip abductors on the stance leg. The
latter hip joint may therefore be abnormal.
22
6. Assisted Trendlenburg test If balance is a problem, face the patient and ask
them to place their hands on yours to support him/her as he/she does alternate
one-legged stance. Increased asymmetrical pressure on one hand indicates a
positive Trendelenburg test, on the side of the abnormal hip
7. A delayed Trendelenburg has also been described, where the pelvic tilt
appears after a minute or so: this indicates abnormal fatiguability of the hip
abductors.
sacro-illiac joint
Apply direct pressure in dimples of lower lumbar region
Localized discomfort in sacro-illiac joint indicate inflammation
o
o
o
o
o
o
Extra articular features of joint diseases

Subcutaneous nodules[Gout, rheumatoid arthritis, SLE]
Cutaneous vasculitic lesions:[RA,SLE,Poly arteritis nodosa]
Lymphadenopathy[Inflammation]
Local edema
Tendon sheath effusions
Enlarged bursa
Investigations
ESR
CRP...................Inflammation with HD and RD risk..Above 3-5Mg
/L
RA factor....................................................Above 20-IU/L
[RA,SLE]
ANA[SLE].................................................[SLE,multipple
sclerosis]
Uric
acid...........................................................................................Gout
Radiology....................................................Ultrasound,X
ray,CT,MRI
Dexa[Dual energy X-ray absorptiometry [Bone mineral Density
test]
23
ICD 10 :
Diseases of Musculoskeletal System and
Connective Tissue
1.
2.
3.
4.
5.
6.
7.
Arthropathies
Systemic Connective
Tissue Diseases
Dorsopathies
Soft Tissue Disorders
Osteopathies
Chondropathies
25
Postinfective arthropathy in syphilis
Postmeningococcal arthritis
Reiter disease
Postimmunization arthropathy
Postdysenteric arthropathy
Reactive arthropathies
Arthropathy following intestinal bypass
Arthritis in Lyme disease
Tuberculous arthritis
Direct infections of joint in infectious and parasitic diseases

Meningococcal arthritis
Pneumococcal arthritis and polyarthritis
Staphylococcal arthritis and polyarthritis
Pyogenic arthritis
Infectious arthropathies
polyneuropathy
pericarditis
myopathy
myocarditis
endocarditis
Rheumatoid arthritis with involvement

of other organs and systems
Rheumatoid:
carditis
Rheumatoid vasculitis
Rheumatoid lung disease
Seropositive rheumatoid arthritis

Felty syndrome
Inflammatory
polyarthropathies
Arthropathies
Other enteropathic arthropathies
Arthropathy in ulcerative colitis
Arthropathy in Crohn disease [regional enteritis]
Psoriatic spondylitis
Arthritis mutilans
Psoriatic and enteropathic arthropathies

Distal interphalangeal psoriatic arthropathy
Inflammatory polyarthropathy
Rheumatoid nodule
Rheumatoid bursitis
Adult-onset Still disease
Other rheumatoid arthritis

Seronegative rheumatoid arthritis
Diseases of Musculoskeletal System and Connective Tissue
Gout
Intermittent hydrarthrosis
Juvenile arthritis in ulcerative colitis
Gout due to impairment of renal function
Drug-induced gout
Lead-induced gout
Arthropathies in other diseases

Gouty arthropathy due to enzyme
defects and other inherited disorders
Other specified arthritis

Allergic arthritis
Traumatic arthropathy
Palindromic rheumatism
Juvenile arthritis in Crohn disease [regional enteritis]
Idiopathic gout
Villonodular synovitis (pigmented)
Kaschin-Beck disease
thyrotoxicosis [hyperthyroidism]
hypothyroidism
haemochromatosis
Arthropathies in other endocrine, nutritional

and metabolic disorders
Arthropathy in:
acromegaly and pituitary gigantism
Arthropathy in amyloidosis
Lipoid dermatoarthritis
Diabetic arthropathy
Crystal arthropathy in other metabolic

disorders
Crystal arthropathy in hyperpar-
sickle-cell disorders
Gouty arthropathy in:

Lesch-Nyhan syndrome
Arthropathies continued
Other specific arthropathies

Chronic postrheumatic arthropathy [Jaccoud]
athyroidism
Familial chondrocalcinosis
Other crystal arthropathies

Hydroxyapatite deposition disease
Juvenile arthritis in other diseases

Juvenile arthritis in psoriasis
Pauciarticular juvenile arthritis
Juvenile polyarthritis (seronegative)
Juvenile arthritis with systemic onset
Juvenile ankylosing spondylitis
Juvenile rheumatoid arthritis
Juvenile arthritis
Whipple disease
sarcoidosis
nodosum
Arthropathy in
erythema:
multiforme
Arthropathies in other specified diseases
Diabetic neuropathic arthropathy
Neuropathic arthropathy
Charcot or tabetic arthropathy
Diseases of Musculoskeletal System and Connective Tissue Continued
Polymyositis
Juvenile dermatomyositis
Dermatopolymyositis
Mucocutaneous lymph node syndrome [Kawasaki]
Juvenile polyarteritis
Polyarteritis with lung involvement [Churg-Strauss]
Polyarteritis nodosa
Polyarteritis nodosa and related conditions
Microscopic polyangiitis
Giant cell arteritis with polymyal

gia rheumatica
Aortic arch syndrome [Takayasu]
Wegener granulomatosis
Lethal midline granuloma
Thrombotic microangiopathy
`Hypersensitivity angiitis
Other necrotizing vasculopathies
Systemic sclerosis induced by

drugs and chemicals
CR(E)ST syndrome
Progressive systemic sclerosis
Systemic sclerosis
Systemic lupus erythematosus

with organ or system involvement
Drug-induced systemic
lupus erythematosus
Systemic lupus erythematosus
Systemic connective tissue disorders
Page No 24
Hypermobility syndrome
Relapsing panniculitis [Weber-Christian]
Multifocal fibrosclerosis
Diffuse (eosinophilic) fasciitis
Polymyalgia rheumatica
Behet disease
Sicca syndrome [Sjgren]
Other systemic involvement of connective tissue
Diseases of Musculoskeletal System and Connective Tissue continued
Neuromuscular scoliosis
Thoracogenic scoliosis
Juvenile idiopathic scoliosis
Scoliosis
Infantile idiopathic scoliosis
lordosis
Flatback syndrome
secondary kyphosis
Kyphosis and lordosis

Postural kyphosis
Deforming dorsopathies
subluxation with myelopathy

Torticollis
Recurrent atlantoaxial
Spondylolisthesis
Spondylolysis
Other deforming dorsopathies
Adult osteochondrosis of spine
Juvenile osteochondrosis of spine
Spinal osteochondrosis
disorders with myelopathy
Other intervertebral disc disorders

Lumbar and other intervertebral disc
Cervical disc disorder

with radiculopathy
Cervical disc disorder with

myelopathy
Other dorsopathies
Cervical disc disorders
Spondylosis
Ankylosing spondylitis
Spondylopathies
Dorsopathies
Dorsalgia
Panniculitis affecting regions
of neck and back
Sacrococcygeal disorders,
Spinal instabilities
Cervicobrachial syndrome
Other dorsopathies,
Cervicocranial syndrome
Schmorl nodes
Lumbar and other intervertebral disc

disorders with radiculopathy
Pain in thoracic spine
Low back pain
Lumbago with sciatica
Sciatica
Cervicalgia
Radiculopathy
Trigger finger
Radial styloid
Contracture of muscle
Muscle wasting and atrophy
calcific tendinitis
Calcification and ossification

of muscles associated with burns
Paralytic calcification and

ossification of muscle
Myositis ossificans progressiva
Muscle (sheath) hernia
Muscle strain
Irritable hip
tenosynovitis [de Quervain]
Calcific tendinitis
Immobility syndrome (paraplegic)
Foreign body granuloma of soft tissue,
infective (teno)synovitis
Ischaemic infarction of muscle
Interstitial myositis
Calcification and ossification of muscle

Myositis ossificans traumatica
Abscess of tendon sheath
rupture of muscle (nontraumatic)
Disorders of synovium and tendon

Synovitis and tenosynovitis
Soft tissue disorders
Infective myositis
Disorders of muscles
Myositis
Other disorders of muscle

Diastasis of muscle
Ganglion
Transient synovitis
Synovial hypertrophy,
contracture of tendon (sheath)
Other disorders of synovium and tendon

Short Achilles tendon (acquired)
of flexor tendons
Spontaneous rupture
of extensor tendons
Spontaneous rupture
Rupture of synovium
Spontaneous rupture
of synovium and tendon
Rupture of popliteal cyst
Rheumatism, unspecified
Myalgia
Pseudosarcomatous fibromatosis
bursitis of hip
Neuralgia and neuritis,
Plantar fascial fibromatosis
Trochanteric bursitis
Necrotizing fasciitis
Knuckle pads
Fibroblastic disorders
Palmar fascial fibromatosis [Dupuytren]
Calcium deposit in bursa
Synovial cyst
of popliteal space [Baker]
infective bursitis
Other bursopathies
Abscess of bursa
bursitis of knee
Prepatellar bursitis
bursitis of elbow
`
Olecranon bursitis
Bursitis of hand
Soft tissue disorders related

to use, overuse and pressure
Chronic crepitant synovitis
of hand and wrist
Hypertrophy of (infrapatellar) fat pad
Other soft tissue disorders
Bursitis of shoulder
Impingement syndrome of shoulder
Calcific tendinitis of shoulder
Bicipital tendinitis
Rotator cuff syndrome
Shoulder lesions
Adhesive capsulitis of shoulder
Syphilitic bursitis
Soft tissue disorders in diseases

Gonococcal bursitis
Soft tissue disorders continued
Residual foreign body in soft tissue
Peroneal tendinitis
Achilles tendinitis
Patellar tendinitis
Tibial collateral
bursitis [Pellegrini-Stieda]
Iliotibial band syndrome
Iliac crest spur
Psoas tendinitis
Fibromyalgia
Metatarsalgia
Calcaneal spur
Periarthritis of wrist
Lateral epicondylitis
Other enthesopathies
Medial epicondylitis
Pain in limb
Enthesopathies of lower limb, excluding foot

Gluteal tendinitis
Stress fracture
Pathological fracture,
Puerperal osteomalacia
Senile osteomalacia
drug-induced osteomalacia in adults
Aluminium bone disease
due to malnutrition
Adult osteomalaci
due to malabsorption
Other cyst of bone
Aneurysmal bone cyst
Solitary bone cyst
Osteitis condensans
Hyperostosis of skull
Skeletal fluorosis
Other disorders of bone density and structure

Fibrous dysplasia (monostotic)
Delayed union of fracture
Adult osteomalacia
Adult osteomalacia
Nonunion of fracture [pseudarthrosis]
Disorders of continuity of bone

Malunion of fracture
Osteoporosis without pathological fracture
Disorders of bone density and structure

Osteoporosis with pathological fracture
Osteopathy after poliomyelitis
Osteolysis
Other hypertrophic osteoarthropathy
Other disorders of bone development and growth

Hypertrophy of bone
Epiphyseal arrest
Chondropathies
Juvenile osteochondrosis
of hip and pelvis
Fracture of bone in neoplastic

disease
Osteitis deformans in
neoplastic disease
Osteonecrosis due to
haemoglobinopathy
Osteonecrosis in
caisson disease
Osteopathy
Paget disease
of bone [osteitis deformans]
Other disorders of bone

Algoneurodystrophy
Periostitis in infectious diseases
Osteopathies in diseases
Tuberculosis of bone
Osteonecrosis
Other osteopathies
Osteomyelitis
Osteopathies and chondropathies
Osseous stenosis of neural canal
Osteochondritis dissecans
Acquired deformity of pelvis
Cauliflower ear
Other disorders of the musculoskeletal system and connective tissue

Acquired deformity of nose
Chondrolysis
Chondromalacia
Relapsing polychondritis
Connective tissue and disc stenosis of intervertebral foramina
Osseous and subluxation stenosis of intervertebral foramina
Intervertebral disc stenosis of neural canal
Connective tissue stenosis of neural canal
Subluxation stenosis of neural canal
Kienbck disease of adults
Other disorders of cartilage

Chondrocostal junction syndrome [Tietze]
Subluxation complex (vertebral)
Biomechanical lesions,
Segmental and somatic dysfunction
epiphysis (nontraumatic)
Other osteochondropathies
Slipped upper femoral
Osteopathies and chondropathies
Bones
Major Diseases of Bones
Osteoporosis
is a progressive bone disease that is characterized by a decrease in bone mass and
density which can lead to an increased risk of fracture.
In osteoporosis, the bone mineral density (BMD) is reduced, bone microarchitecture
deteriorates, and the amount and variety of proteins in bone are altered. Osteoporosis is defined
by the World Health Organization (WHO) as a bone mineral density of 2.5 standard deviations
or more below the mean peak bone mass (average of young, healthy adults) as measured by
dual-energy X-ray absorptiometry;
The term "established osteoporosis" includes the presence of a fragility fracture. The
disease may be classified as primary type 1, primary type 2, or secondary. The form of
osteoporosis most common in women after menopause is referred to as primary type 1 or
postmenopausal osteoporosis. Primary type 2 osteoporosis or senile osteoporosis occurs after
age 75 and is seen in both females and males at a ratio of 2:1. Secondary osteoporosis may arise
at any age and affect men and women equally. This form results from chronic predisposing
medical problems or disease, or prolonged use of medications such as glucocorticoids, when the
disease is called steroid- or glucocorticoid-induced osteoporosis.
Osteomalacia
is the softening of the bones caused by defective bone mineralization secondary to
inadequate amounts of available phosphorus and calcium, or because of overactive resorption of
calcium from the bone as a result of hyperparathyroidism (which causes hypercalcemia, in
contrast to other aetiologies).
Osteomalacia in children is known as rickets, and because of this, use of the term
osteomalacia is often restricted to the milder, adult form of the disease. It may show signs as
diffuse body pains, muscle weakness, and fragility of the bones. The most common cause of the
disease is a deficiency in vitamin D, which is normally obtained from the diet and/or from
sunlight exposure.
Osteomyelitis
is infection and inflammation of the bone or bone marrow
Types
Suppurative osteomyelitis
Acute suppurative osteomyelitis
Chronic suppurative osteomyelitis
Primary (no preceding phase)
Secondary (follows an acute phase)
Non-suppurative osteomyelitis
Diffuse sclerosing
Focal sclerosing (condensing osteitis)
Proliferative periostitis
Osteoradionecrosis
25
Osteogenesis Imperfecta
This disease is a genetic disorder that is characterized by brittle bones that break or
fracture easily. It is caused by a gene defect in the production of collagen, a protein that is
needed to make bones strong. Osteogenesis imperfecta even affects the bones in the inner ear
and can cause hearing loss, as well as weak teeth and a curved spine.
Bone Cancers
According to the National Cancer Institute, bone cancer may be due to a primary cancer
that begins in the bone or spreads to the bone as secondary cancer from another part of the body
such as cancer in the lungs, breast or prostate. There are several types of primary bone cancers
such as leukemia, osteosarcoma, Ewing sarcoma, malignant fibrous histiocytoma and
chondrosarcoma.
Rickets
This preventable bone disease affects young children and is caused by a deficiency of the
nutrient vitamin D. Rickets causes weak, brittle bones that fracture easily and bone and muscle
pain.
Acromegaly
Acromegaly is a bone condition caused by excess of growth hormone production by the
body. Overgrown bones in the face, hands and feet characterize this disease. The most common
cause of acromegaly is a benign tumor on the pituitary gland in the brain.
Fibrous Dysplasia
Fibrous dysplasia results in excessive growth or swelling of bone due to abnormal cell
development. There are several types of fibrous dysplasia that mainly affect the bones of the
skull, face, ribs, upper arms, pelvis, thighs and shins.
26
Repertory of Osteopathies
o Bone tumors-Acid Nit,Aur met,Acid flour,Hecla lava,Kali iod,
o Bone Pains-Aur met,Phos,Sulph,Eup perf,Acid nit,Rhus tox,Hepar
sulph,China,Agaricus,Lach,Lyc,Kali
iod,Mez,Manganum,Bell,Causticum
o Degenerations-Aur met,Phos,Sulph,Eup perf,
o Inflammations-Aur met[C/c inflammation],Thuja,Acid
phos,Lyc,Manganum,Rhus tox,Hecla lava,
o Swelling-Staph,Asafoetida,Hecla lava
o Suppuration-Sil,Staph
o Ulceration-Sil,Calc flour,Asfoetida,Hecla lava,
o Abcess-Sil
o Neurosis-Phos,Thuja,Hepar sulph,Hecla lava,
o Exostosis,Aur met,Phos,Kali iod
o Softening,Phos,Calc phos,Thuja,Asfoetida,Lyc
o Curvature-Phos
o Growth impairment-Cal Phos,Calc Carb
o Gout-Sulph
o Osteoporosis-Aur met,Sil
o Cancer-Phos
o Injury-Ruta,Symphytum
o Nodosities-Calc flour,Hecla lava
27
Bone Materia Medica

Remedies with prominent emotional
symptoms
Aurum Met
[Osteoporotic,SDC]
General Features :
1,mental states of great
depression a. Hopeless, despondent,
2,Feeling of self-condemnation and
utter worthlessness.
Bone Symptoms
Bone pains < night
Bone degeneration
Painful upper Jaw
Swelling of skull bone
Exostosis
Chronic inflammation of bone

Asfoetida[Infmn][Hysetrical]
General Features :
1,Hysterical, nervous symptoms
Fear of paralysis. Tendancy to faint.
hypochondriacal patients
Bone Symptoms
Ulceration and curvature of

bones [Syphilitic]
Bone and periosteal

inflammation
Foetid discharges,Faints
Night pains in bones covered by

skin
Thuja[Softening]
General Features :
1,Emotional sensitiveness,FEELINGS OF
WORHTLESSNESS. SECRETIVE,
2,Feel lonely and empty.

Depressions,Mistrustful.
3,Delusion as if her leg is fragile
Bone Symptoms
Feeling as if flesh torn from

bones
[Apis,lach,Nit acid,Rhus tox]
Fragile sensation of bones
Inflammation,necrosis. Acid
phos[Infmn]
General Features :
1,WEAKNESS AND ENFEEBLEMENT
OF THE EMOTIONAL PLANE,Suffers in
silence. Long grief
2,Signs of Depression,INDIFFERENCE,
APATHY.
Interstitial inflammation of
bones
Periosteitiis
Hip diseases and carries

ofbones[weakness and
enfeeblement of emotional
plain]
Staph[Indignation]
General Features :
1,Ailments from INDIGNATION,
MORTIFICATION, ROMANTIC
DISAPPOINTMENTS. Suppression of
emotions,
anger, grief.
1,GENTLE, SWEET and MILD
Bone Symptoms
Pressing ,stinging,tearing pain in

bones of cranium
Swelling or suppuration of bones

after surgery
Nigh < of pains

Acid nit
General Features :
1,UNFORGIVENESS. Hatred,
unmoved by apologies. Emotionally
isolated.
28
Bone Symptoms
splinter like pains
Feeling as if flesh torn from

bones
Bone tumors[Hard
Peronality,unforgiveness
Aurum Ars[Osteoporotic]
General Features :Hard
personalities.Hard working without
emotional feelings.critical of himself and
constantly finding fault with others.
Bone Symptoms
Carries of bones.Osteomyelitis,SLE,CA
bone
Aurum Iodatum
General Features :
History of long standing depression or some
chronic involvement of the thyroid or a
history of swollen, indurated painful glands.
heart problem preceeds the mental
derangement.
Bone Symptoms
CA metastasis to bones,
Pain restlessness and numbness,
Band around sensation.Right sided
sciatica<Sitting ,lying
Remedies with Predominently

Osteoporotic Tendancy
Aurum met&Aurum Ars[Explained
in first part]
Phos[Osteoporotic]
Carries of bones
CA Bone
Burning pains
Rheumatic bone pains
Necrosis of Jaw bone
Exostosis and carries with necrosis
Acid flour[Osteoporotic]
Carries of long bones
Burning pain in bones
Exostosis
Felons
Felones with discharges
Carries of teeth
Hecla lava[[Osteoporotic]
Nodosities and carries of bones
Necrosis and ulcerations
Swelling of shin bones
Tumors
Aranea Diadema[Osteoporotic]
Periosteitis or carries of bones.Icy cold
sensation of bones
Calcarea Hypophosphorica[Osteoprotic]
Calc Flour[Osteoporotic,softening]
Malnutrition of bones
Bone tumors
Bruices of bones
Nodules in bones
Ulceration of bones

Osteomylitis Tendancy
Silicea [Osteoporotic,Infmn]
Suppuraion of bones
Carries of long bones
Stabbing pain[Flouric acid]
Spine disease [Potts]
Curature and abcess
Ulceration of bones
Echondroma
Bone abcess
Mezerium[Infmn]
Inflammed long bones[Tibia]
Periostitis with pain <night,Damp,Touch]
Osteitis [Mez,Asf]
Decay of tooth
Cheek bone neuralgia [Silicea]
Merc sol[Similar to silicea]
Suppurative bone diseases with pain < night
Asfoetida[[Explained in first part]
Acid phos[[Explained in first part]
Manganum
Painful periosteitis <night
Sensitive to touch
Inflammation of articular extrimities of
bones
29
Bell
Bone pains inflammatory
Aranea Diadema[Explained
in first part]
Softening Tendancy
Calc carb[Softening]
Soft bone
Curvature
Spine bone pain < Touch
Faulty bone development
Large bones affected
Calc phos[Softening]
Bone softening and curvature
Non union of bones
Growing end of all bone affected
Brittle thin bones
Thuja[Softening][Explained in first
part]
Calc Flour[Explained in first part]

injury effects
Ruta[Injury,Strain]
Injury to bones
Hip pain
Sprain and dislocations
Silicea and Merc Sol[Explained in first
part]
Staphysagria[After Surgery]
Calc Flour[Explained in first part]
Sulph
Bone pains as if flesh detached from bones
Carries and indurations
Gout in various Joints
Eup perf[Viral&postviral]
General soreness of bones
Bone pains during fever,aching pain
Break bone fever
Rhus tox
Leg bones painful at night
Aching pains in all bones
Nose bone painful
Hepar Sulph
Pain in bones < night
Necrosis of nasal bones
Kali iodide
Bone tumors of orbit
Osteitis and perostitis of bones
Exostosis
Bone pains at night
Lyc
Inflammation and softening of bones
Night aggravation of pains
Arg nit
Face bone pains
Cramping pain
Periosteitis and osteitis
Perichondritis
Pain in figer bones
Lach
Shin bone pains
Agaricus
Shin bone pains
Symphytum
Non union of fractured bones
Injuries
Zinc met
Neuralgic pain in face bones
Arnica
Bone pais after trauma
Causticum
Face bone pains
Other remedies
Castor Equi
Rt Tibia and coccyx painful
30
Joints
Diseases of Joints
Inflammatory Joint Diseases [Source Encyclopedia Britanica]
Bursitis
Inflammation of a synovial bursa, the lubricating sac located over
a joint or between tendons and muscles or bones, is called bursitis (or bursal
synovitis). Bursas sometimes are affected along with the joints and tendon
sheaths in rheumatoid arthritis and gout. Infectious agents introduced by
penetrating wounds or borne by the bloodstream also may result in bursitis,
but this is unusual.
Infectious Arthritis
Joints may be infected by many types of microorganisms
(bacteria, fungi, viruses) and occasionally by animal parasites. There are
three routes of infection: by direct contamination, by way of the bloodstream,
and by extension from adjacent bony infections (osteomyelitis). Direct
contamination usually arises from penetrating wounds but may also occur
during surgery on joints. Blood-borne infections may enter the joints through
the synovial blood vessels. Commonly, however, foci of osteomyelitis occur
first in the long bones near the end of the shaft or next to the joint. The
infection then extends into the joint through natural openings or pathological
breaches in the outside layer, or cortex, of the bone. Characteristically,
hematogenous (blood-borne) infectious arthritis affects one joint
(monarthritis) or a very few joints (oligoarthritis) rather than many of them
(polyarthritis) and usually affects large joints (knee and hip) rather than
small ones. Infections of the joints, like infections elsewhere in the body, often
cause fever and other systemic indications of inflammation.
Tuberculosis, Brucellosis, leprosy,rubella (German measles),Guinea
worm,sexually transmitted diseases, Reactive arthritis (Reiter disease)
Rheumatoid arthritis and allied disorders

In several types of arthritis that resemble infectious joint disease, no
causative agent has been isolated. Principal among these is rheumatoid
arthritis. This disorder may appear at any age but is most usual in the fourth
and fifth decades. A type that affects children is called juvenile rheumatoid
31
arthritis. Rheumatoid arthritis typically affects the same joints on both sides
of the body. Almost any movable joint can be involved, but the fingers, wrists,
and knees are particularly susceptible. The joints are especially stiff when the
affected person awakes. Rheumatoid arthritis is not only a disease of the
joints; fatigue and anemia indicate that there is a more generalized systemic
joints; fatigue and anemia indicate that there is a more generalized systemic
involvement. A slight fever may sometimes be present. Lesions also occur in
sites outside the joints. Involvement of bursas, tendons, and tendon sheaths is
an integral part of the disease. Approximately one of five affected persons has
nodules in the subcutaneous tissue at the point of the elbow or elsewhere.
Inflammatory changes also are found sometimes in small arteries and the
pericardiumthe membrane enclosing the heart.
Related Arthritis--Sjgren syndrome,Felty syndrome, Psoriatic arthritis,
Ankylosing spondylitis,
Collagen diseases
The collagen diseases are so called because in all of them abnormalities
develop in the collagen-containing connective tissue. These diseases are
primarily systemic and are frequently accompanied by joint problems. One of
these diseases, systemic lupus erythematosus (SLE), may affect any structure
or organ of the body. An association with rheumatoid arthritis is suggested by
the fact that one-quarter of those with SLE have positive serological tests for
rheumatoid factor, and perhaps as many patients with rheumatoid arthritis
have positive lupus erythematosus tests. In another collagen disease,
generalized scleroderma, the skin becomes thickened and tight. Similar
changes occur in other organs, particularly the gastrointestinal tract.
Examples-Rheumatic Fever,SLE
Miscellaneous arthrities
Several types of arthritis appear to be related to a hypersensitivity
reaction. Erythema nodosum is a skin disease characterized by the formation
of reddened nodules usually on the front of the legs. In the majority of cases,
pain may arise in various joints, and sometimes swelling appears. Lymph
nodes at the hilus of the lung (the site of entrance of bronchus, blood vessels,
and nerves) are enlarged. The synovitis disappears in the course of several
weeks or months. Many cases of erythema nodosum are associated with drug
hypersensitivity, with infections such as tuberculosis, coccidioidomycosis, and
leprosy, and with sarcoidosis, a systemic disease in which nodules form in the
lymph nodes and other organs and structures of the body. Synovitis of this
sort occurs in 10 to 15 percent of patients with sarcoidosis.
Palindromic rheumatism is a disease of unknown cause that is characterized
by attacks that last one or two days but leave no permanent effects.
32
Nevertheless, palindromic rheumatism rarely remits completely, and

approximately one-third of cases result in rheumatoid arthritis. Polymyalgia
rheumatica, a relatively frequent condition occurring in older people, is
characterized by aching and stiffness in the muscles in the region of the hips
and shoulders, but the joints proper do not seem to be involved. There does
seem to be some relationship to a type of arterial inflammation called giant
cell arteritis. Polymyalgia rheumatica is not usually accompanied by serious
systemic abnormalities
Noninflammatory joint diseases

Injury and degenerative disorders
Traumatic joint diseases

Degenerative joint disease
Osteoarthritis is a ubiquitous disorder affecting all adults to a greater
or lesser degree by the time they have reached middle age. The name
osteoarthritis is a misnomer insofar as its suffix implies that the condition has
an inherently inflammatory nature. For this reason it frequently is called
degenerative joint disease, osteoarthrosis, or arthrosis deformans. When the
spine is involved, the corresponding term is spondylosis. Unlike rheumatoid
arthritis, osteoarthritis is not a systemic disease and rarely causes crippling
deformities. In the majority of instances, the milder anatomical changes are
not accompanied by appreciable symptoms. The changes are characterized
by abrasive wearing away of the articular cartilage concurrent with a
reshaping of adjacent ends of the bones. As a result, masses of newly
proliferated bone (osteophytes) protrude from the margins of the joints.
The clinical manifestations of osteoarthritis vary with the location and
severity of the lesions. The most disabling form of the disorder occurs in the
hip joint, where it is known as malum coxae senilis. Osteoarthritis of the hip,
like that of other joints, is classified as primary or secondary. In secondary
osteoarthritis the changes occur as a consequence of some antecedent
structural or postural abnormality of the joint. In about half the cases,
however, even rigorous examination fails to disclose such an abnormality; in
these instances the osteoarthritis is called primary.
Congenital and hereditary abnormalities

1, arthrogryposis multiplex congenita (multiple congenital crooked joints),
2,Clubfoot (talipes equinovarus
3,Idiopathic scoliosis (lateral curvature of the spine)
4,spondylolysis
5, genetically influenced metabolic diseases [Gout, alkaptonuria,,
chondrocalcinosis, or pseudogout
33
6,Hurler syndrome, Marfan syndrome.

Secondary joint diseases Hemorrhagic joint diseases
Hemarthrosis (bleeding into the joints) is a major complication of
hemorrhagic disorders. Aside from the life-threatening episodes of bleeding,
it constitutes the principal disability arising from the hemophilias. Most
persons with these clotting defects are affected and usually within the first
years of life. Bleeding into the joints is usually caused by relatively minor
injury but may leave several residual deformities and loss of mobility of the
part. Recurrent hemorrhage into an isolated joint, in the absence of a
systemic tendency to bleed, is characteristic of pigmented villonodular
synovitis, a tumour characterized by abnormal thickening and coloration of
the synovial membrane.
Aseptic necrosis
Because joint cartilages are without blood vessels, they are not destroyed by
failures in the blood supply. Nevertheless, several joint diseases arise in
association with aseptic necrosistissue death not caused by infectionof
bone next to the joints.
Examples-decompression sickness (caisson disease),sickle cell anemia, LeggCalv-Perthes disease
Endocrine factors
acromegaly,Cretinism,hypothyroidism,dwarfism diabetes mellitus,
Neurogenic arthropathy
Neurogenic arthropathy, also known as Charcot joint, is a severe
degenerative disease related to nerve lesions that develops when the sensory
mechanisms of joints are impaired. The current view is that these joints
become excessively strained because the ability to receive stimuli from bodily
structures and organs necessary for normal limitation of motion is lacking.
As a result, the supporting tissues are torn, and there is extreme
disintegration of the structure. Neurogenic arthropathy is most often
associated with diabetes mellitus, tabes dorsalis (a late form of syphilis
affecting the posterior columns of the spinal cord), syringomyelia (a disease in
which cavities develop in the gray substance of the spinal cord), pernicious
anemia, and leprosy. The disease usually is localized to one joint or one group
of joints, depending on the location of the nerve defect. Pain is frequently
mild considering the massive distortion of the joint. Treatment is difficult and
is based primarily on immobilization and restriction of weight bearing.
Hypertrophic osteoarthropathy
In approximately 5 to 10 percent of persons who have primary tumours
within the chest, the ends of the bones near the joints become enlarged and
painful. New bone is formed in the periosteum, and only occasionally do
34
abnormalities develop within the joints themselves. Just how the chest abnor
mality leads to hypertrophic osteoarthropathy (disease of bones and joints
with abnormal growth of bone)
Reflex sympathetic dystrophy

Reflex sympathetic dystrophyalso called shoulder-hand syndrome
because pain in the shoulder is associated with pain, swelling, and stiffness of
the handonly rarely develops in the wake of external injury. Most often it
follows a heart attack (myocardial infarction) or is associated with disease in
the neck vertebrae; frequently there is no apparent cause. Most often the
syndrome begins with pain and stiffness of a shoulder, followed shortly by
pain and swelling of the hand, with vascular (blood vessel) changes in the skin
of the hand. Over the course of several months, the swelling and vascular
changes subside, but the skin and soft tissues become tightened. These
changes sometimes disappear completely, but in other cases they leave
permanent contracturesi.e., flexion and loss of mobility due to the
tightening of the fingers. Loss of mineral occurs in the bones of the shoulder,
wrist, and fingers. Blocking (interruption of functioning) of sympathetic
nerves serving the area
Tumours of joints
Tumours of joints are uncommon. In synovial chondromatosis, a
benign condition, numerous cartilaginous nodules form in the soft tissues of
the joint. The lesion is usually confined to one joint, particularly the knee,
and occurs in young or middle-aged adults. It may or may not cause pain or
swelling and usually is cured by excision of a portion of the synovial
membrane. The tumour rarely becomes malignant. The cartilaginous nodules
sometimes also contain islands of bone; in this circumstance the lesion is
called synovial osteochondromatosis. Like synovial chondromatosis, synovial
osteochondromatosis is often a spontaneous or primary disorder of unknown
cause. In many cases, however, it is a development secondary to other
diseases of the synovium, such as rheumatoid arthritis and even
osteoarthritis.
Synoviomas, or synovial sarcomas, are malignant tumours that arise in
the tissues around the jointsthe capsule, the tendon sheaths, the bursas, the
fasciae, and the intermuscular septa, or divisionsand only rarely within the
joint proper. Although they may occur at any age, they are most frequent in
adolescents and young adults. The legs are more often involved than the
arms. The tumours spread locally and also to regional lymph nodes and
lungs. Synoviomas are not particularly sensitive to X-rays, and treatment
with drugs has been ineffective. If distant spread has not occurred at the time
the condition is identified, radical excision, which may include amputation of
the part, is the recommended treatment.
35
Repertory of Arthropathies
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
Bruiced feel :Mez

Burning pain:Phos
Contusive Pain: Nat Mur
Cracking: Led pal,Calc,Sulph,Nat
mur,Phos,Thuja,Kalicarb,Nat Sulph,Zinc,Kali
bich,Ruta,Caulophylum,Benz Acid,Rhodo
Deposits: Sulph
Distortion: Guacum,Merc sole,Cal phos,
Effusion: Bry
Enlargement:Thuja
Exudation:Sulph,Abrotanum,Silicea
Gout:Led pal,Puls,Lyc,Colocynth,Arn,Asfoetida,Benz
acid,Guacum,Calc flour,Formic acid,Aesculus
Hardening:Thuja
Heart affecting: Nat sulph ,Kalmia
Induration:Calc Flour
Inflammation:Rhodo,Benz Acid
Injury:Bry,Arnica,Ruta,Strontium
Nodositis:Led pal,Sulph,Nat
mur,Staph,Caul,Ruta,Calc,Asf,Benz acid,Guacum
Paralysis:Causticum
Paralytic Weaness:Rhus tox,Lyc,Sepia,Valariana
Rigidity:Rhus,Sulph,Lyc,Caust,Sep,M
sol,Phos,Bell,Manganum,Kali bich,Ars,Guacum,Actea
Shifting pain:Colchicum,Puls,Bry,Sulph,Arn,Caul,Kalmia
Stitching pain:Kali carb
Suppuration:Silica,Abrotanum
Swelling:Rhus,Calc,Bry,Phos,Thuja,Asf,Lach,Medo,Actea
SpicSynovitis:Bry,Colch,Apis,Calc
Flour,Aesculus,Ferrum Phos
Tearing pain:Phos
Tenderness:Colchicum
36
Meteria Medica Of
Arthropathy
Remedies with Generalised joint
affections
Sulph[Generalized]
General Features
Generalised rheumatism
Absorbs Inflmation exudate from joints
Absorb deposits from joints
Arthritic swelling with cracking on
movement
Inflammatory swelling of joints
Stiffness
Cannot walk erect; stoop-shouldered
Specific Joint Symptoms
1,Shoulder knee hip pains
2,Drawing pain between shoulders.
Stiffness of nape.
3,Rheumatic pain in left shoulder.
Heaviness; paretic feeling.
4,Burning in soles and hands at night.
5,Stiffness of knees and ankles.
Bry[Generalized]
General Features
Serous membrane affected
Cavities,joins and ligaments affected
Movement <
Sinovitis,efusion,hot swelling
Inflammation and stitching pan
Cold > . Injury to joints when arnica fails
1,RHEUMATISM of joints and muscles,
arthritis, gout; inflammation of joints
with swelling and stiffness.
2,agg. Motion, heat;
3,amel. rest, cold, pressure.
Lyc [Generalized][Gouty]
General Features
Stiffness of all joints
Profuse sweat of feet,Numbness
Chronic gout and chalky deposits
> by gentle movement
1,Shoulder pain,Paralytic pain[Rt]Heavines
2,Inflammation of Finger joits
3,Pain in heel on treading as from a pebble.

Painful callosities
4,Sciatica, worse right side
5,toes and fingers contracted
Kali bich[Generalized]
General Features,Joint Symptoms
Pain, swelling and stiffness and crackling of
all joints,Loud cracking
Stiffness,Affects fibrou tissue
Shifting rheumatism
Pains in small spots
Left-sided sciatica; better, motion.
Ars Alb[Generalized]
General Features
Trembling, twitching, spasms, weakness,
heaviness,
Burning pains. Peripheral neuritis.
Paralysis of lower limbs with atrophy.
Right shoulder pain
Shifting pains
Rheumatic pains alternating with headache
> ,warmth
Calc phos[Softening][Generalized]
General Features
It has a special affinity where bones form
sutures or symphyses
Bone softening and curvature
Non union of bones
Growing end of all bone affected
Brittle thin bones
Soreness in sacro-iliac symphysis,
as if broken. [Aesc.hip.]
Stiffness and pain, with cold, numb
feeling,worse any change of weather
Lachesis
General Features
Bluish swelling of joints
Rheumatic pain in left side, then in right,
and frequently alternating, at times from
right to left and back again, always in
different places, in shoulder, arm, wrist,
hand, lower limbs, knee, calf, foot and teeth.
37
Formica Rufa[Gouty]
General Features
Chronic gout and stiffness
Nodes around joints
Ligaments,capsules and bursa affected
General rheumatism
Rheumatic pains; stiff and contracted joints.
pains worse, motion; better, pressure. Right
side most
Mag Phos[Gouty]
General Features
Gouty rheumatic pains.
Weakness in arms and hands, finger-tips
stiff and numb. General
muscular weakness.
Gouty Remedies
Ledum Pal[Wrist,hip,fingers][Gouty]
General Features
Ascending rheumatism,Nodosities
Gout stones,Cracking in joints
,Tearing pain
Affects small joints
1,Ball of great to swollen
2,Right shoulder throbbing pain
Modalities
<Walking and stepping
> by rest
Gout deposits in wrist,fingers and toes
Cold application >
Lyc [Generalized][Gouty]
Explained in first part
Puls[Wrist,fingers][Gouty]
General Features
Gout and rheumatism
Wandering pain[Shifting]
Subacute rheumatism
Knee,ankle or small joints
SENSATION OF COLD WATER
POURED DOWN THE BACK.
HOT FEET, UNCOVER THEM AT
NIGHT
Pains in the heels
Modalities
COLD APPLICATIONS,>
Evening < ,> by slow movement
Colocynth[Hip][Gouty]
General Features
Rheumatic pain and stiffnesss,Gout
Stiffness of joints and,shortening of tendons
Contraction of,the muscles. Pain down right
thigh; muscles and tendons feel,too short
Nerve related pain in hip,Pain in hip
shooting to feet,Right hip
inflammations,Cramp-like pain in hip;Left
Knee stiffness.
Colchicum[Finger joints,Ankle][Gouty]
General Features
Smaller joints affected more
Shifting rheumatism
Tenderness,Deposits in joint
Screaming on touching joits
Arthritic pain affecting synovial membrane
Inflammation of great toe, gout in heel,
cannot bear to have it touched or moved.
Modalities
Stiffness < Night
< evening and warm weather
Asafoetida[Gouty]
General Features
The flatulence and spasmodic contraction of
stomach and
oesophagus
Rheumatism and arthritis
Nodosities ,gout
Wrist and forearm affections
Swelling of ankle
Benzoic acid[Knee]
General Features
urine,highly colored and very offensive, and
gouty symptoms.Gouty concretions
Inflammatory swelling
Cracking,Shifting pains
Pain in nodes
Gout -Knee joint affinity
Bunion of great toe.
swelling of the wrist.
Guajcum[Gouty]
38
General Features
Joint swelling,Painful,Rheumatic sore throat
Rigidity,Gout nodes
C/c rheumatism with distorted joints by
concretions
Aching in nape. Stiff neck and sore
shoulders.
Rheumatic pain in shoulders, arms and
hands.
Growing pains.
lumbago.
Ankle pain extending up the leg,
Modalities
< warmth,movement,wet weather
Calc Flour[Gout]
General Features
Indurated swelling
Gout,
Facia and capsular ligament enlarged[Knee]
Chronic lumbago; aggravated on beginning
to move, and ameliorated on continued
motion
Gouty enlargements of the joints of the
fingers. Exostoses
on fingers.
Chronic synovitis of knee-joint
Abrotanum[Gouty]
General Features
Gout stiffness
Painful contraction of limbs.
[Amm.mur.]
Aggravation of haemorrhoids when
rheumatism
improves,
Wrist and ankle joint pain
Pricking sensations
Exudations in joints
Pain in sacrum, with haemorrhoids.
Pain in shoulders, arms, wrists, and ankles.
Rhododendron[Gouty]
General Features
Rheumatism
in the hot season.
All symptoms reappear in rough weather,
Arthritic nodosities,Gout,Cracking in joint

Gouty inflammation of great
toe-joint,Stiffness of neck. Pain
in shoulders, arms, wrists;
Modalities
worse when at rest. befor storm.
Aesculus[Hip,Sacroilliac][Gouty]
General Features
Fullness sensation
Gouty rheumatic affections
Aching and soreness in limbs, in left
Aching pain in right hip,Right thigh
painful,Sacroilliac joint painful
Aching and soreness acromion,process with
shooting down arms; finger tips numb.
Lameness in neck; aching between shoulder
blades;
Backache affecting sacrum and hips;
worse walking or stooping.
Mag Phos[Gouty]
Gouty rheumatic pains.
Cramps in calves. Sciatica
Writers' and players'cramp.
Weakness in arms and hands, finger-tips
stiff and numb. General
muscular weakness.
Ammonium Phos[Gouty][Elbow,Knee]
Constitutional Gout with Nodosities of
joints,
Arthriis deformans
nodosities of the joints of the fingers
and backs of the hands. .
Pain in shoulder-joint.
Oxalic Acid[Back,Gouty]
Acute pain in back extending to thighs,Pain
in spots[Kali Bich]
Numb, weak, tingling. Pains start from
spine and extend through extremities.
Drawing and lancinating pains
shooting down extremities. Backache; Wrist
painful, as if sprained
Uric Acid [Gouty]
6th potency used for eliminating uric acid
deposits
39
Actea Spicata[Gouty,Wrist,finger joints]

Gouty rheumatism of small joints for
females
Swelling of joints from slight fatigue
Paralytic weakness in the hands. Lame
feeling in arms
Medorrhinum
Chronic rheumatism.
Pain in back, with burning heat.
Legs heavy ,ache all night; cannot keep
them still
Heels and balls of feet tender. Soreness of
soles.Restless,Gouty concretions
Puffy enlargement of finger joints
[Knuckles]
APOCYNUM ANDROSAEMIFOLIUM
Gouty rheumatic pains all over,Burning in
foot sole,Every thing smells like
honey..When sulphur fails[Q]
Arg met
General Features
Affects cartillages of joints
Sore pain in joints
Gouty arthritis
Rheumatic affections of joints, especially
elbow and knee. Legs weak and trembling,
worse descending
stairs
writer's cramp. Swelling of ankles.
Other Joint Remedies

Rhus tox
General Features
Affects fibrous tissue and tendon sheath
Tenderness,swelling and pain
Rigidity and paralytic weakness of joints
Maxillary joint pain
Stiffness of the nape of the neck.
ain and stiffness in small of back
Sciatica; worse, cold, damp weather, at
night. Numbness,
Loss of power in forearm and fingers

Modalities
First move <
Waking up <
> continous motion
Damp <
Calc Carb[Knee,Hip]
General Features
Over responsible,hard working,cold<
Joint swelling especially in knees
Arthritic node in wrists and fingers
Cracking and crepetition
Swelling of joints, especially knee. Burning
of soles of feet.
Curvature of dorsal vertebrae. Nape of neck
stiff and rigid
Causticum[Hip]
General Features
Chronic rheumatic, arthritic
and paralytic affections, indicated by the
tearing, drawing pains in the muscular and
fibrous tissues, with deformities,Stiff joints
Chronic rheumatism
Joint inflammations,Burning in joints.
Tearing pain in joints
Cracking and tension in knees; stiffness in
hollow of knee.Cracking and tension in
knees,Hip affections
Sepia
General Features
Arthritic pain in joints with stiffness
Paralytic pain in limbs
Ulcers on joints and tip of fingers
Pains extend into back.
Coldness between shoulders.
Coldness of legs and feet.
Lower extremities lame and stiff, tension as
if too short. Heaviness and bruised feeling.
Pain in heel.
Nat mur[Shoulder,ankle]
General Features
Cracking in joints on movement
C/C rheumatism
40
Lameness and sprained sensation

Rigidity,Easy dislocations
Nodosities
Ankles weak and turn easily. Painful
contraction of hamstrings. [Caust.]
Contusive pain in shoulder
Pain in back, with desire for some firm
support.
Merc sol[Wrist]
General Features
Swelling of joint of fingers
Stiffness of wrist
Rheumatic pain of thigh,knee< night and
movement,very sensitive to cold
Sensation of coldness of affected parts
Complete destruction of joints
Dropsical swelling of feet and legs.
Phos[Shoulder]
General Features
Stiffness of joints
Swelling,burning pain
Tearing pain at night
Paralytic weakness of joints
Acute inflammation of joints
Cracking in shoulder joints
Burning ,Stitching pain in right shoulder
Stitching pain in elbow
Burning in back; pain as if broken. Heat
between the shoulder-blades.
Thuja
General Features
When walking, limbs feel as if made of
wood
or glass, and would break easily
Cracking in joits
Cracking in maxillary joints
Wart near joints
Fibrous part of joints affected
swelling of joints
HARDENING, HYPERTROPHY
Osteoarthopathy-Enlarged joints
Joint inflammation
Joint pain < damp,<Rest
Silicea[Hip,Ankle]
Hip joint diseases

Chronic suppuration of joints
Weakness of ankle joint
Aconite
Rheumatic inflammation of joints at night
Intolerable pain after exposure to cold
Kali carb[Shoulder,Hip]
General Features
Sharp stitching pains
Fibrous tissue,ligaments afected
Shoulder pain,Hip joint diseases,
Pain in nates and thighs and hip-joint.
Hip to knee pain
Small of back feels weak. Stiffness and
paralytic,feeling in back. Burning in spine.
White swelling of knee
Lacerating in wrist-joint.
Staphysagria[Maxillary]
General Features
Arthritic nodosities of joints of fingers
Stiff joints
Maxillary joint painful
Hip joint pain,Dull aching
of nates extending to hip-joint and small of
back
Backache; worse in morning before rising
Natrum Sulph[Hip]
General Features
Pain in hip,Cracking in joints
Rheumatic arthritis of joint[Fingers]
Sycotic origin
Cracking on motion
Change of position <
Tendency to shift to Heart
worse in damp cold weather.
Pain in hip-joints, worse left,
worse,stooping.
Stiffness of knees, cracking of joints.
Bell
Joint pains come and go suddenly
41
Stiffnes of joints of hands and feet

Maxillary joint painful
Zinc Met
General Features
Transverse pain in limbs,Stiffness
Fidgety of foot
Pain in small of back. Cannot bear back
touched.
Dull aching about the last dorsal or first
lumbar vertebrae; worse sitting.
Burning along spine. Nape of neck weary
from writing or any exertion.
Arnica
General Features
After traumatic injuries, overuse of any
organ, strains,Gout,
Fear of being touched.
Traumatism of grief, remorse or sudden
realization of financial loss
Pain in joits as if sprained
Pain in back and limbs, as if bruised or
beaten.,Rheumatism begins low down and
works up.[Ledum.]
Shifting pain,Arthritic pains with fear of
touch while walking
Manganum Aceticum[Shoulder]
Periosteal pain in shoulder
Shifting rheumatism
Pain <Night
inflammation of bones and joints with
insupportable nightly digging pains.
walks on metacarpo-phalangeal joint
Ankles painful.
Ruta[Shoulder,elbow]
General Features
Fibrous deposits in joints
Pain as if beaten,After injury to joints
Upper extrimities of large joints affected
Complaints from straining flexor tendons
especially.
Tendency to the formation of deposits in the
periosteum, tendons, and about joints,
especially wrist
Elbow painful,Cracking in joints
Shoulder pain while hanging down

Caulophylum[Finger,ankle,toes]
General Features
Rheumatism of small joints
Changing and shifting pains
Finger,toe,and ankle affected[Viola
Odorata]
Phallangeal and meta carpo phallangeal
joint pains and cracking
Severe drawing, erratic pain and stiffness
in small joints, fingers, toes, ankles, etc.
Aching in wrists. Cutting
pains on closing hands
Phytolacca[Hip]
General Features
Glandular,fibrous and ossious tissue
affected
Hip joint disease
Aching pains in lumbar region; pains
streaking up and down spine into sacrum.
Weakness and dull pain
Back stiff, especially in morning on rising
and during damp weather.
Kalmia
Rheumatic pains shifting
Rheumatic pericarditis
Ascending Rheumatism
Deltoid rheumatism especially right.
Painsfrom hips to knees and feet
Apis
Oedematous. Synovitis
Rheumatic pain in back and
limbs; Tired, bruised feeling. Numbness of
hands and tips of fingers
Knee swollen, shiny, sensitive, sore, with
stinging pain. Feet swollen and stiff.
Pain < least movement,Sharp pains
Strontium carb
Sciatica with oedema of ankle.
Chronic sprain of ankle joint with edema
Rheumaticpain in right shoulder.
Icy-cold feet
42
Actea spicata
Rheumatism of small joints,wrist
,finger,ankle
Slight fatigue leads to swelling especially
ankle joint.
Lac can
Rheumatic pains in extremities and back,
from one side to the other. Pain in arms to
fingers. Burning in
palms and soles.
Rheumatic pain < Evening
Actea racemosa[Neck]
Intercostal rheumatism.
Rheumatism of vertebral joints especially of
neck
Rheumatic pains in muscles of back and
neck. Pain in lumbar
and sacral region, down thighs, and through
hips
Inflammation and stiffness in morning
Joints of hand,feet and wrists affected
Sangunaria
Rheumatism of right shoulder and left hip
and nape of neck
Burning in soles and palms
pains in places least covered by flesh
Ferrum Phos
Stiff neck.
Inflammation of joints[Hip]
Articular Rheumatism especilally
shoulder,pains extend to chest and
wrist,Synovitis
Lactic Acid(Wrists,shoulder, elbows and

small joints)
Articular and Muscular Rheumatism
Rheumatic pain in joints and shoulders,
wrists,
knees, with much weakness<night,Diabetes
may accompany.
Angusta Vera
Paralytstiffness,weakness.Rheumatism tend
to paralysis,Torticolis,numbness to
paralysis..6x
Argemone Mexicana
Rheumatism accompanied by renal
diseases[Brights][Q]
Asclepius Tuberosa
Intercostal Neralgia<lying,movement[Bry]
Badiaga
Arthritic and rheumatic diseases,Chronic
rheumatism,After injuries..Muscle
soreness< cold and movement[ oppsite to
Rhustox]
Calc Caustica
Poly arthritis and RA.Stiffness and tearing
pain. Tearing neuralgic pain in shoulder to
arm.
Camphor
Local rheumatic conditions in cold climates
Cascara Sangrada
Rheumatism of muscles and joints with
obstinate constipation.Q-6X
Valeriana
Lancinating pain in ankle
,knee,elbow,shoulder,
Heel pain<sitting.
Pain < when stop walking
Salicylic Acid
A/c inflammatory rheumatism,High
fever,<least jar
Knees swollen and painful. Acute articular
rheumatism; worse, touch and motion
43
Joint Affinity Diagram

Side afinity not considered
Staph
Rhus tox
Bell
Valariana
Aesculus
Sangunarea
Lyc
Nat Mur
Phos
Kali Carb
Manganum
Ruta
Ars Alb
Mez,Acid flour
Ferrum Phos
Calc Sulph
M sol
Ledum Pal
Puls
Actea Spic
Asfoetida
Abrotanum
Ruta
Valariana
Aesculus
Caulophylum
Nat Sulph
Lyc
Ledum Pal
Puls
M sol
Colchicum
Actea Racemosa
Medorrhinum
Staph
Ledum
Calc
Sulph
Causticum
Colocynth
Silicea
Kali Carb
Calc Phos
Phytolacca
Aesculus
Ferrum Phos
Natrum Sulph
Sangunarea
Generalised Joint Affections
Sulph
Lyc
Bry
Arn
Kali Bich
Ars alb
Cal Phos
Lach
Formica Rufa
Mag Phos
Calc Carb
Sulph
Bry
M sol
Benz Acid
Caulophylum
Locomotor System Treatment Protocol

Dr.Sreekumar.M.B [9447084496]
Actea Racemosa
Puls
Silicea
Colchicum
Calc Phos
Asafoetida
Caulophylum
Viola Odorata
Strontium Carb
Actea Spicata
Abrotanum Valariana
Soft Tissue Affections

Muscles
Tendons
Ligaments
Bursa
Membranes
44
Materia Medica of Muscular Affections

Myositis
Actea Racemosa
muscular and crampy pains, primarily of neurotic origin, occurring in nearly every
part of the body, are characteristic,Pains like electric shocks here and there
In muscular rheumatism and myositis caused by cold, nervous exhaustion, or over-exertion, this
will be found a valuable remedy.
Rheumatic myositis
Thuja
myositis ossificans
Pain and stiffness occur in nape and back, associated with a bruised sensation. Rheumatic pains
in various sites are accompanied by numbness,worse damp humid atmosphere,Muscular
twitchings, weakness and trembling
Bell
Inflammation of muscles [myositis]tiff neck. Pain in nape,
as if it would break. Pressure on dorsal region most painful.
Arnica
Traumatic Myositis,A muscular tonic.Rheumatism of muscular and tendinous tissue, especially
of back and shoulders
Bryonia
Rheumatic Myositis,Painful stiffness in nape of neck. Stitches and stiffness in small of back.
Calcarea
Nape of neck stiff and rigid. cramps in calves,Tearing in muscles.
Myositis
Hamamelis[Tired feeling in arms and legs. Very sore muscles and joints.]
Hepar[weak muscles,Myositis]
Merc Sol[Myositis]
Rhus tox[Myositis]
Ruta[Traumatic Myositis]
Bellis Per[muscular soreness. Lameness, as if sprained,Joints sore, muscular soreness. Itching
on back and flexor surfaces of thighs.
Badiaga
Muscle soreness< cold and movement[ oppsite to Rhustox].Bloody extravasations .Blue skin
Muscle Wasting
Plumbum Met
The muscular tissue throughout the body is wasted or contracted.
45
Progressive muscular atrophy or wasting palsy.

Paralysis of the extensor muscles of the fore-arm, accompanied by wasting of their substance.
Carbonium Sulph
The muscular masses of the extremities are considerably wasted, the emaciation being specially
marked in the muscles of the legs and those of the forearms.
The triceps muscle is flabby and wasted
Ars Alb
Muscles of extremities are wasted and atrophied.
Kali H iodatum
Great debility, especially when attended by marasmus and wasting of muscular tissue.
Iodum
Iodine has great absorbent action, which is rapid and intense; muscles, fat, tissues and glands
waste away and general emaciation is the result.
Kali Phos
Muscle wasting
Phos
Fatty degeneration of muscles
Abrotanum
Wasting of lower extremitis
Merc Sol
Symmetric wasting of muscles of both arms
Calc Phos
Muscle wasting
Ferrum Phos
Muscle wasting
Tendons
Rhus tox
Rhus affects fibrous tissue markedly-joints, tendons, sheaths-aponeurosis, etc., producing pains
and stiffness.
Pains tearing in tendons, ligaments, and fasciae.
Muscle or tendon strains, stiffness or soreness especially from over-lifting or overreaching; agg.
on grasping.
Causticum
Contracted tendons.
Contracted tendons; palms (Nat-m.), hamstrings, etc.
Contraction of the tendons of the fingers.
Contraction of flexor tendons.
46
Contraction and tension in the heel and tendo Achillis.

Contraction of the tendons, and stiffness in the flexor muscles of the limbs.
Ruta
Ganglion on flexor tendons.
Feeling as if the tendons under the knees were shortened.
Complaints from straining flexor tendons especially.
Tendency to the formation of deposits in the periosteum, tendons, and about joints, especially
wrist.
Sulph
Tension as from shortening of tendons, especially of feet.
Contractions of tendons .
Ammonium Mur
It is one of the remedies when there is contraction of the hamstring tendons, which seem tight
when walking, amel. by continued motion.
Contraction of the tendons under the knee.Chronic sprains
Contraction of hamstring tendons.
Contraction of tendons of popliteal spaces and stiff knee joints.
Feels as if the tendons and muscles are contracted
Beriberis Vulg
Painful swelling of tendo-achillis and heels.
contraction of muscles and tendons - contraction, soles
Silicea
Contraction of flexor tendons; painful when moving fingers.
Calc Caustica
Left tendo achilis pain
Sepia
Tension in the tendo-Achilles.
the pain is usually in the middle of the Achilles tendon in a small spot.
Pain on the head of the humerus, on the tendon of the pectoral muscle, on bending back the arm
and touching it.
Tension in the tendons above the knee, on going up stairs.
Thuja
Pain and contraction in tendons especially Achilis tendon.
Bry
Sharp rheumatic pain in tendon of trapezius on turning head to left.
Sensation in tendo-achillis as if bruised. Rheumatic attack.
Zincum Met
Erysipelatous inflammation and swelling of tendo Achillis.
Arnica
47
Arnica has a specific action upon the muscles, especially centering upon their fasciae and
tendons, producing irritation and myalgia.
Rheumatism of the muscular and tendinous tissues of the back and other parts
Calc Carb
Tearing in the tendo Achillis
Actea Racemosa
Pain in left tendo-achillis when walking in open air, and a shortening sensation.
Anacardium
It has been found useful in injuries of tendons and in chronic rheumatic troubles.
Wounded tendons
Contraction of muscles and tendons,especially Tendo Achilis
Cimex Lectularius
Flexor tendons affected.Sensation as if tendons contracted .Cannot be streatched
Ligaments
Rhus tox
rheumatic affection of the muscles and ligaments, alleviated by motion
Chronic rheumatism of muscles, ligaments, and fasciae
Rhus toxicodendron corresponds especially to injuries of the ligaments
Bry
Shooting, tensive pain in ligaments of left shoulder-joint
Inflammation of ligaments
Calc flour
Swelings or indurated enlargements having their seat in the fasciae and capsular ligaments of
joints, or in the tendons.
Hyper mobile joints, laxity of ligaments.
LOOSENESS OF LIGAMENTS, OVEREXTENSION JOINTS
Beriberis Vulg
Shooting pain poarts ligament[Inguinal]
Caulophylum
Drawing pain in Uterine ligaments
Relaxation of muscles and ligaments.
Colchicum
Rheumatic affections of ligamets
Ruta
Inflammation of ligaments especially from injuries
Causticum
48
Rheumatism of the tendons and ligaments,ending in the joints shrivelling and ultimate
ankylosis[similar to Guiac.]
Kali Carb
Affections of lumbar and uterine ligments
Bursae
Silicea
Enlarged bursa over the patella. Bursa on back of hand.
Inflammation of bursae in shoulder and knee.
Sticta
Bursitis in knee joint, simple or diffused and shoulder joint.
Ruta
Bursitis of shoulder,Knee ,wrists and finger joints.
Sulph
Inflammation,hardnes,cystic swelling and hardnes of bursae.
Kali Mur
Inflammation of bursae of knee.
Arnica
Inflammation of bursae of knee.[Trumatic]
Stannum Met
Inflammation of bursae of knee and wrist
Calc flour
Bursitis
Rhus tox
Bursitis
Bellis Per
Generalised inflammation of bursae
Causticum
Cysts in Bursae
49
Membranes
Bryonia
It absorbs all effusion off the synovial sac.
Synovial swellings. Synovial inflammation of knee joints.
Apis
Synovitis, especially in the knee, which is swollen and shiny, with stinging pains, extreme
sensitiveness (from a bruise).Sharp lancinating, stinging pains shooting through the joint and
aggravation from the slightest motion.
Puls
The remedy is indicated in rheumatism of the joints, and in gouty, gonorrhoeal and traumatic
synovitis. The joint is, of course, swollen, and the pains are of a sharp stinging character.
Calc Flour
Inflammation of knee-joint, chronic synovitis.
Swelling of elbow-joint, crepitation, showing want of synovial fluid.
Sulph
Synovitis, especially when there is considerable exudation, particularly in the knee.
Silicea
Chronic synovitis of knee with great swelling and anchylosis.Exudation of synovial fluid in
wrist.
Natrum Phos
Synovial crepitation
Merc Sol
This remedy suits syphilitic or strumous synovitis, with tendency to complete destruction of the
joint
Ledum Pal
Synovitis of knee, with great sensitiveness, trembling and numbness of the extremities on
attempting to walk.
Other medicines for Snovitis
Iodum,Bell,Ferrum Phos,Ruta,Calc
50
Accessory and supportive Care

External Oils&Ointments
Rhus Tox Oil
Arnica Oil
Apis mellifica Oil
Camphora officinalis Oil
Cantharis Oil
Ledum pal Oil
Antiinflammatory Ointmets
Orthopedic Supporting Materials
Ankle support & splints,

Ankle trauma without fracture,
Immobilization of the joint,
Postoperative synovitis,
Degenerative sprain or inflammations of the joints,
In rehabilitation
Sports
Back & lumber support, [Lumbosacral Corset]

51
Indications
Acute sprains and strains
Post surgical fusion, laminectomy, discectomy
Congenital or traumatic instability
Disc herniation
Spinal stenosis
Postural backache
Fractures
Degenerative joint/disc disease
Elbow support,
Lateral epicondylitis (Tennis Elbow)
Medial epicondylitis (Golfer's Elbow)
Strains and sprains
Arthritis or Bursitis
Epicondylitis
Knee braces and supports.[Knee suppot plain]

Arthritis of the knee
Bursitis of the knee
Chondromalacia patella
Lateral or medial collateral ligament sprains
Lateral or medial instability of the knee
Patellar tendinitis
52
Shoulder Supports
Rotator cuff repairs
Postoperative Bankhart procedures
Capsular shifts
Glenohumeral dislocations or subluxation
Soft tissue shoulder strains or repairs
Neck Supports[Hard&soft Cervical Collar]

Spondylitis
Thigh and Calf Supports
Life style management
is also important in preventing and treating the locomotor

diseases.Diet,excersise and stress management should also be adviced according to the nature of
the case.
Fracture Management
Non-Surgical Fractures can be managed in a Homoeoathic primary health care system. Doctors
and staff should be adequately trained for fracture management.
53
Rehabilitation
measures shall be adviced and provided to patients developing

irriversible locomotor disabilities.
Physiotherapy Indications
TRACTION
Indications
- Nerve root compression, disc herniation that responded with decreased pain to manual traction
- Where joint stiffness, torsional and compressive stresses are found e.g. spondylosis, spinal
stenosis
Contraindications
- Active inflammatory ( rheumatoid ) or infective arthritis
- Signs and symptoms of cauda equina, spinal cord lesions
- Signs of vertebral artery disease
- Joint and ligament instability, fracture/ dislocation
- Increased pain with traction or manual therapy
- Active bone disease or malignancy
- Non-mechanical causes of pain
MANUAL THERAPY
Indications
- Mechanical joint pain provoked by movement
- Joint movement restriction and/or mal-alignment
- Spondylosis, disc lesions, nerve root compression with accompanying joint stiffness and malalignment
- Muscle imbalance and tightness
Contraindications- same as above
ULTRASOUND
Ultrasound promotes increased blood flow, tissue healing, muscle relaxation and scar tissue
breakdown.
Indications
- Soft tissue lesions e.g. muscle strains, tendinopathy, ligament sprains, muscle spasm, tension
and tightness
- Areas of swelling and chronic inflammation
Contraindications
- Patients with reduced sensation to pain and/or heat
- Pregnancy (direct exposure to abdomen)
- Local malignancy
- Local acute infection
- Direct application to the eye, brain, spinal cord, heart, reproductive organs, epiphyseal regions
in children
- Over areas of thrombosis or other vascular abnormalities
INTERFERENTIAL THERAPY
Interferential therapy is a modality that applies currents at around 4000 Hz through the affected
area of a patient. Four electrodes are placed in such a way that allows two currents to cross each
other and penetrate deep within a joint or body area.
Indications
- Pain relief / anaesthetic effect by stimulating the release of endorphins and blocking the
transmission of pain impulses (pain gate mechanism).
- Increase in blood flow to promote tissue healing and reduce swelling/ inflammation
54
- Muscle stimulation to activate weak muscles and overcome muscle inhibition caused by the
injury
Contraindications- Patients with pacemakers,Near the low back or abdomen of pregnant
Pathological view Of
Musculoskeletal System
Pain and inflammation - Anti inflammatory medicines
Rheumatoid diseases- Anti rheumatoid agents
Muscle inflammation -Anti inflammatory medicines
Bone inflammation -Anti inflammatory medicines
Tendon Inflammation- Anti inflammatory medicines
Ligament inflammation -Anti inflammatory medicines
Bursa inflammation- Anti inflammatory medicines
Sprains - Anti inflammatory medicines+Local applications+Immmobilizing
supports
Muscle spasms - Mucle relaxants
Fibrosistis - Anti inflammatory medicines
Spondylitis - Anti inflammatory medicines
Tenosynovitis - Anti inflammatory medicines
Degnerated Bone tissue[Osteo arthritis] - Nutritional Suppliment
[Calcium,Vitamin D]
Fever - Anti pyretics
Pain - Analgesics
Injuries
Gouty arthritis - Anti inflammatory medicines
Acute pain management -Anti inflammatory medicines and analgesics in
appropriate potency
Surgery is indicated in severe mechanical
jointdiseases[Example - Knee replacement surgery in osteoarthritis]
55
Bone
Cartillages
Joint
Muscles
Ligaments
Tendons
Bursa
Membranes
Fluids
Others
Potency
Thirst/Thirstless
Hot/Chilly
Remarks
Target
Medicines
3x to 12 x
3x to 30
30
Thirsty
Hot
inflammation
appearing at
every change in
weather.
periosteum
inflamed,pains
at night
Merc Sol
3x to 30
30
Thirsty
Chilly
Hot
thirstless
Inflammatory
rheumatism,
aggravated by
rest, change
position frequently,
*
*
*
Rhus tox
acute inflammatory
rheumatism.
stretched-tight
feeling due to
edema
*
*
Apis Mel
Compiled By:Dr.Srekumar.M.B. Mob:9447084496
3x to 30
Thirsty
Thirsty
Thirst/
thirstless
Chilly
Chilly
Chilly
*
*
Belladonna
Acute and
chronic
rheumatism.
rheumatic stiff
neck
*
*
*
*
*
Aconite
Brought on by
sudden changes
in the temperature, from warm
to cold, windy
weather.
First stage of all

inflammatory
affections.
Wounds &
Inflammation
and heat of the
soft parts.Fever
asociated.
Ferrum Phos
30
thirstless
Chilly
301M
Thirsty
Chilly
chronic
inflammation and
caries of
the joints
*
*
*
*
Silicea
Page No.56
Syphilitic
rheumatism
,Bone
pains,Tendo
achilitis,Sciatica
*
*
Kali Bich
Homoeopathic Anti Inflammatory Drugs For Locomotor Diseases
Bone
Cartillages
Joint
Muscles
Ligaments
Tendons
Bursa
Membranes
Fluids
Others
Thirstless/
Thirsty
30-1M
Potency
30
Thirstless
Traumatic
Inflammation.
Localised
rheumatism
due to cold or
overexertion
*
*
30-1M
Thirsty
Chilly
Carries of
bones including
vertebra.Burning
pains
Phosphorus
Sulphur
30-1M
Thirsty
Hot
acute and
chronic
rheumatism.
Ascending
,worse in
bed,IExudations
Q-30
Thirsty
Chilly
Hot
Hot
Acute inflammation of the

spine.Flying
pains in the
joints; rheumatic inflammation.
RheumaticGouty
Inflammation.gouty,
gonorrhoeal and
traumatic
synovitis
serous
effusion.Acute
inflammatory
rheumatism,
synovial
membranes are
inflamed. No
violent fever
VeratrumViride Arnica
Pulsatilla
Bryonia
Thirst/Thirstless
Hot/Chilly
Remarks
Target
Medicines
30-1M
Thirsty
Chilly
30-1M
Thirsty
Chilly
Chronic
inflammation
and nightly
bonepains.Caries
of the nasal,
palatine, and
mastoid
Aurum Met
Page No.57
Inflammation
of cartillages
especially of
ear,nose
tarsal bones
Arg Nit
Bone
Cartillages
Joint
Muscles
Ligaments
Tendons
Bursa
Membranes
Fluids
Others
Thirsty
3x
Potency
Inflammation
of great toe,
gout in heel,
cannot bear to
have it
touched or
moved.
*
*
*
Colchicum
Thirst/Thirstless
Hot/Chilly
Remarks
Target
Medicines
3x
30
Thirsty
Hot
Inflammation
of joints of
fingers.
.Inflammation;
Caries of
bones
Flouric Acid
6x-30
Inflammation
of Membranes
especially
spine
Zincum Met
30
Chilly
Hot
Thirsty
long bones,
inflamed and
swollen;
caries, exostosis; pain
<night, touch,
damp weather
Mezerium
Joints inflamed
and painful.
SEROUS
MEMBRANES.
Inflammation;
Effusion
Iodum
periosteal
inflammations,
ulcers, shin
bones. intolerance of all
dressings.
Asafoetida
inflammation.
Inflammation of kneejoint,
chronic
synovitis.
Calcarea
Flour
Articular
inflammatory rheumatism of the
small joints,
hands and
feet, in
women.
Caulophyllum
Page No.58
Bone
Cartillages
Joint
Muscles
Ligaments
Tendons
Bursa
Membranes
Fluids
Others
Potency
Thirst/Thirstless
Hot/Chilly
Remarks
Target
Medicines
Q to 30
Thirsty
FIBROUS
TISSUE.
Rheumatoid
Inflammation.
*
*
Stillingia
30
Inflammatory rheumatism with

neuralgic
pains
Hypericum
*
*
*
*
*
30
30
Traumatic
Inflammation
inflammation of neck
.Over use
muscles and
cervical
bones
Ruta
Inflammatory
rheumatism
with neuralgic
pains
Gouty soreness
and inflamed
nodosities of
joints, associated with
headache.
Chilly
Eupatorium Per Gaultheria
Actea
Racemosa
Gouty
Inflammations
Guajcum
30
Gouty
Inflammations
Benzoic Acid
Page No.59

Email.drsreekumarjessy@yahoo.co.in
Sticta
Inflammatory rheumatism of small joints
Rhododendron
Acute inflammatory swelling of joints, wandering from one joint to another; severe at night; < in rest and during rough
stormy weather
Ledum Pal
General tendency to rheumatic inflammations, especially of the joints, with soreness of the muscles, without fever.
Manganum
Inflammation of both bones and periosteum, with insupportable digging pains at night, and great weakness of the joints.
Causticum
Rheumatic and arthritic inflammations with contractions of the flexors and stiffness of the joints.
Phytolacca
Chronic rheumatism of lower extremities; chronic inflammation of the knee-joints,
Abrotanum
Inflammatory rheumatism before the swelling has appeared; also in cases of gout, when the wrist and ankle joints are painful
and swollen.
Lactic Acid
rheumatic inflammation of elbows, knees and small joints of upper and lower extremities
Kalmia
Inflammatory rheumatism, shifting from joint to joint, with tendency to attack the heart,[Lithium Carb] high fever, excruciating pains, which, of course, are made worse by motion
Other Anti Inflammatory Drugs for Locomotor System
Page No.60
Case Taking Performa

Locomotor System
Priliminary Data
Reg No:
Date of admission:
Name of doctor:
Name of the patient:
Age:
Place of Birth:
Religion:
Name of Guardian:
Occupation:
Address:
Provisional Diagnosis:
I P NO:
Ward:
Date of Discharge:
Sex:
Marital status:
Veg/Nonveg:
Telephone:
Final Diagnosis:
Signature of doctor
Presenting Complaints
Region Affected
Pain .....................................................................
Stiffness ..............................................................
Numbness ............................................................
Swelling ..............................................................
Nodosities ...........................................................
Cracking ..............................................................
Joint Locking .......................................................
Crepitition ...........................................................
Sprain .................................................................
Injury ...................................................................
Dislocation .........................................................
Exostosis .............................................................
Other Symptoms.........................................................
...................................................................................
...................................................................................
...................................................................................
Generalized
Specific to one or more joints
Distribution
Bone
Cartilages
Joint
Muscle
Ligaments
Tendons
Bursa
Membranes
Referred
Side
L
Temparo-Mandibular R
R
L
Skull bone
R
L
Jaw Bone
L
Neck[Cervical Spine] R
Muscles of Neck
R
L
Thoracic Spine
R
L
Lumbar Spine
R
L
Sacral Spine
R
L
Coccyx
R
L
Scapular region
R
L
Shoulder
R
L
Intercostal area
R
L
Costo-chondral joints R
L
Elbow
R
L
Wrist
R
L
Inter-phallangeal joints R
L
R
L
Soft tissues of arm
R
L
Hip
Sacro-illiac joint
R
L
Knee
R
L
Ankle
R
L
Joints of Foot bones R
L
Soft tissues of L E
R
L
Others...........................................
.....................................................
.....................................................
.....................................................
Summary of Presenting complaints.............................................................................................

....................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................
How the problem started;............................................................................................................
....................................................................................................................................................
......................................................................................................................................................
Difficulty in Activities of Daily Living
Dressing bathing toilett
Walking
Mechanical Joint Diseases

Inflammatory Joint diseases
Symptoms,Senstions,Concomitance and Modalities

......................................................................................................................................................
......................................................................................................................................................
......................................................................................................................................................
......................................................................................................................................................
Short History
:.................................................................................................................
:.................................................................................................................
Mental Features
:.................................................................................................................
:.................................................................................................................
Physical generals
:.................................................................................................................
:.................................................................................................................
Particulars
:.................................................................................................................
:.................................................................................................................
Family history
:.................................................................................................................
Examination
General observations
Gait,.........................................................................................................................
Posture,....................................................................................................................
Mobility,..................................................................................................................
Deformity,................................................................................................................
Independence,..........................................................................................................
Muscle wasting,.......................................................................................................
fractures,..................................................................................................................
Examination of bones
Inspection
Alteration in shape or outline,shortening,.....................................................................
Bowing of long bones,..................................................................................................
Epiphysial enlargement,................................................................................................
Osteochondral enlargement,..........................................................................................
Localized swelling of bones ,.......................................................................................
Spontaneous fracture,....................................................................................................
Palpation
Tenderness,...................................................................................................................
Fractures,......................................................................................................................
Findings in Individual Joints

The spine
Cervical spine(C1C7)
Thoracic spine(T1T12)
Lumbar spine(L1L5)
Sacrum(S1S5)
Coccyx(35)
Non-specific musculoskeletal pain
sciatica
Examination
gait- Slow Limited by pain,.........................
skin abnormalities- Inflammation ...................
Curvature- Normal Abnormal......................
Range of motion,..................................................
Para-spinal pain ............................................
Vetebral Pain .................................................
Tender Spine
................................................
Parasthesia .....................................................
Angular deformities .......................................
Painful restriction, .........................................
Pain and limitation SLR ...................................
Other Findings,...........................................................................................................................
...................................................................................................................................................
...................................................................................................................................................
Sacroiliac Joints
Local Tenderness
Other Findings,...........................................................................................................................
...................................................................................................................................................
...................................................................................................................................................
Shoulder
External landmarks
Acromion......................................
Clavicle.........................................
Scapula.........................................
Deltoid muscle.............................
Supraspinatus..............................
Infraspinatus................................
Teres Minor...................................
Pain/limitation on active ROM
but not present with passive ROM
Abduction
Adduction&Internal rotation
Forward flexion
Active ROM
Findings
Abduction.......................................................
........................................................................
Adduction&
Internal rotation ...........................................
........................................................................
Forward flexion.............................................
........................................................................
Passive ROM
Findings
Abduction......................................................
........................................................................
Adduction&
Internal rotation ..........................................
........................................................................
Forward flexion.............................................
........................................................................
Other Findings
Impingement
Sub Acromial Bursitis
Acromio-Clavicular Joint disease
...........................................................................................................................................
...........................................................................................................................................
...........................................................................................................................................
Elbow
Medial Epicondylitis (golfers elbow)
Lateral Epicondylitis (tennis elbow)
Olecranon Bursitis
Other Findings.............................................................................................................................
....................................................................................................................................................
Wrist
Inflammatory Arthritis
Carpal Tunnel Syndrome
Dupuytrens Contracture
Tenosynovitis of the Thumb
Other Findings.............................................................................................................................
....................................................................................................................................................
Fingers
Heberdens Nodes
Other Findings.............................................................................................................................
....................................................................................................................................................
Hip
Trenlenberg Test Positive Negetive
Other Findings.............................................................................................................................
....................................................................................................................................................
Knee
Bowing (varus)
Knock-kneed(valgus)
atrophy of the
quadriceps
Hamstring
calf muscle
Patellar Tap
Positive Negetive
crackling/grinding sensation
Joint Line Tenderness
Ligament Injury
Prepatellar Bursitis
Infra Patellar Bursitis
Posterior Knee cysts in popliteal fossa
Other Findings.............................................................................................................................
....................................................................................................................................................
Ankle
Valgus deformity
Varus deformity
Flattening
Other Findings.............................................................................................................................
....................................................................................................................................................
Extra articular features of joint diseases

Subcutaneous nodules[Gout,rheumatoid arthritis,SLE]
Cutaneous vasculitic lesions:[RA,SLE,Poly arteritis nodosa]
Lymphadenopathy[Inflammation]
Local edema
Tendon sheath effusions
Enlarged bursae
Investigations
ESR.................................................................................................
CRP.................................................................................................
RA factor.........................................................................................
ANA[SLE]......................................................................................
Uric acid.........................................................................................
Radiology........................................................................................
Others..............................................................................................
Summary
1,......................................................................................................................................
2,......................................................................................................................................
3,......................................................................................................................................
4,......................................................................................................................................
5,......................................................................................................................................
6,......................................................................................................................................
7,......................................................................................................................................
8,......................................................................................................................................
9,......................................................................................................................................
10,....................................................................................................................................
11,....................................................................................................................................
12,....................................................................................................................................
13,....................................................................................................................................
14,....................................................................................................................................
15,....................................................................................................................................
16,....................................................................................................................................
17,....................................................................................................................................
18,....................................................................................................................................
19,....................................................................................................................................
20,....................................................................................................................................
Diagnosis:.....................................................................................................................................
Prescription:..................................................................................................................................
Supportive Treatment Adviced:.....................................................................................................
Medical Officer attended

1,Name ,Institution & signature.......................................................................................................
Follow-up

Locomotor System Study Guide

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Locomotor System Study Guide

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Study Material

Human Locomotor SyStem

This is a collection of clinical and therapeutic information collected from various

Origin of the symptom

Common symptoms of joint

Mechanical Joint Diseases Features

o Feeling of inactivity stiffness on long rest and disappears suddenly on activity

Inflammatory Joint diseases Features

Alteration in shape or outline, shortening

o Spontaneous fracture-Secondary carcinoma, multiple myeloma,

Range of movement[Compare with corresponding side]

Over view of Spine

The low back is formed by 5 lumbar

Common Benign pain syndromes

Specific problems in back

Often referred to as "sciatica," this is a pain syndrome caused by irritation

Examination Keys: Spine

Examination shall be conducted in erect posture

root irritation as cause of pain. . If the straight leg test is positive,

The shoulder joint is created by the confluence of 3 bony

Active ROM [Range of Movement]

Adduction and Internal rotation Ask the patient to place

Forward flexion: Ask the patient to trace out an arc while

move their hand to a position over their head. Normal range is

Passive ROM[Range of Movement]

If there is pain with active ROM, assess the same

Pain/limitation on active ROM but not present with

Impingement-common cause of shoulder pain

Impingement:[To encroch] lead to tendonitis and bursitis.

Limitations of clinical examination

to make on clinical grounds .So MRI is an extremely helpful tool

Elbow, Wrist, Finger joints

Lateral Epicondylitis (tenniselbow): Presentation and

Reproducibility of pain with resisted wrist extension

Olecranon Bursitis : The olecranon process is formed by the

Carpal Tunnel Syndrome(Calc-p., Guaj., Viol-o,Causticum)

Watch the patient walk. Do they limp or appear to be in pain? When

External anatomy, noting structures above and below the

Joint Line Tenderness:

Infrapatella : Below the knee. Also

Inspection done while the patient is standing

Ischaemic or trophic changes

Inspection done while supine[edit]

The hip should be examined for:

Apply direct pressure in dimples of lower lumbar region

Localized discomfort in sacro-illiac joint indicate inflammation

Extra articular features of joint diseases

Postinfective arthropathy in syphilis

Arthritis in Lyme disease

Direct infections of joint in infectious and parasitic diseases

Pneumococcal arthritis and polyarthritis

Staphylococcal arthritis and polyarthritis

Rheumatoid arthritis with involvement

Rheumatoid lung disease

Seropositive rheumatoid arthritis

Other enteropathic arthropathies

Arthropathy in ulcerative colitis

Arthropathy in Crohn disease [regional enteritis]

Psoriatic and enteropathic arthropathies

Adult-onset Still disease

Other rheumatoid arthritis

Diseases of Musculoskeletal System and Connective Tissue