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Article outlineIntroduction- Key words- Knee anatomy (not described here)- Common knee disorders and their miasmatic analysis- Homoeopathic Treatment Introduction Knee joint pain is a very common complaint, being not only uncomfortable but causing lot of anxiety. It is often associated with ageing process but no age is immune. To study knee pain, one must be acquainted with anatomy of knee joint. Key wordsOsteoarthrosisThis is the form of arthritis characterized by erosion of articular cartilage, either primary or secondary to trauma or other conditions. The articular cartilage becomes soft, frayed, and thinned with eburnation of subchondral bone and outgrowths of marginal osteophytes. It results in pain and loss of function and mainly affects weight-bearing joints. It is more common in older persons. Rheumatoid arthritisIt is a systemic disease, occurring more often in women, which affects connective tissue. Arthritis is the dominant clinical manifestation, involving many joints, especially those of the hands and feet, accompanied by thickening of articular soft tissue, with extension of synovial tissue over articular cartilages, which become eroded. Its course is variable but often is chronic and progressive and it often leads to deformities and disability. Ankylosing spondylitisThis is the arthritis of the spine, resembling rheumatoid arthritis that may progress to bony ankylosis with lipping of vertebral margins. This disease is more common in the male often with the rheumatoid factor absent and the HLA antigen present. There is a striking association with the B27 tissue type and the strong familial aggregation suggest an
listlessness. disturbances in growth.important genetic factor. Osteomalacia- . and sometimes tetany. with decreased cortical thickness and a decrease in the number and size of the trabeculae of cancellous bone (but normal chemical composition). Psoriatic arthritisIt is the concurrence of psoriasis and polyarthritis. and idiopathic. which can affect juveniles. gout is a feature of the Lesch-Nyhan syndrome an X-linked disorder. resulting from a variety of abnormalities of purine metabolism.age-associated osteoporosis. characterized by a raised but variable blood uric acid level and severe recurrent acute arthritis of sudden onset resulting from deposition of crystals of sodium urate in connective tissues and articular cartilage. In this disese. occurring especially in men. The most cases are inherited. It is associated with skeletal deformities. OsteoporosisThis is a condition of reduced bone mass. fractures are frequent. however.postmenopausal osteoporosis. hypocalcemia. and generalized muscular weakness. premenopausal women. It is usually accompanied by irritability. resembling rheumatoid arthritis but thought to be a specific disease entity. Type 2. and middle-aged men) and secondary osteoporosis (which results from an identifiable cause of bone mass loss). the mechanism. remains obscure. The familial aggregation is for the most part galtonian with a threshold of expression determined by the solubility of uric acid. perhaps inherited as an autosomal dominant. GoutIt is a disorder of purine metabolism. However. RicketsIt is a disease due to vitamin-D deficiency and characterized by overproduction and deficient calcification of osteoid tissue. It results in increased fracture incidence. Osteoporosis is classified as primary (Type 1. seronegative for rheumatoid factor and often involving the digits.
and bending of weight-bearing bones. repeated joint trauma and effusion. Paget’s DiseaseIt is a generalized skeletal disease. osteosarcoma. of older persons in which bone resorption and formation are both increased. associated with articular chondrocalcinosis is called as pseudogout. Eving’s sarcoma etc. The extensor mechanism of the knee Extension of the knee is produced by the quadriceps muscle acting through the quadriceps ligament. It is a disease characterized by gradual softening and bending of the bones with varying severity of pain. Tumours of KneeThese may be benign or malignant. leading to thickening and softening of bones (e. There is often a vicious circle of pain- . Malignant ones may be metastatic.g. patellar ligament and tibial tubercle. frequently familial. Weakness of extension. viz. Osteomalacia often begins during pregnancy. patella. Genu valgum or Knock knees It is a deformity marked by lateral angulation of the leg in relation to the thigh. Tibia vara or Genu varum It is a deformity marked by medial angulation of the leg in relation to the thigh or an outward bowing of the legs.It leads to instability. It is more common in women than in men.It is also called as adult rickets. The softening occurs because the bones contain osteoid tissue which has failed to calcify due to lack of vitamin D or renal tubular dysfunction. PseudogoutAcute episodes of synovitis caused by deposits of calcium pyrophosphate crystals rather than urate crytals as in true gout. the skull)..
Weakness of the quadriceps is also sometimes found in lesions of the upper lumbar intervertebral discs.→quadriceps inhibition →quadriceps wasting →knee instability →ligament stretching and further injury →pain.It also leads to instability. as there is failure of the screw-home mechanism. in multiple sclerosis and other neurological disorders. Common causes of knee pain Type of Lesion Diagnosis Psora Degenerative Osteoarthrosis + Sycosis ++ Miasm Syphilis +++ Pseudopsora Cancerous + Traumatic (Post Injury) Knee sprain ++ + . Loss of full extension. which becomes tender and prominent.seen in children in the 10–14 age group.(often thought to be due to a partial avulsion of the tibial tuberosity) which occurs in the 10–16 age group. Radiographs may show partial detachment or fragmentation. In an older age group (16–30) the patellar ligament itself may become painful and tender. Rapid wasting of the quadriceps is seen in all painful and inflammatory conditions of the knee. as a sequel to poliomyelitis. Osgood Schlatter’s disease. Quadriceps wasting may be the presenting feature of a diabetic neuropathy or secondary to femoral nerve palsy from an iliacus haematoma. In it there is recurrent pain over the tibial tuberosity. Pain generally ceases with closure of the epiphysis. and there may be a history of giving-way of the knee. This almost invariably occurs in athletes. and in the myopathies. where there are X-ray changes in the distal pole of the patella. Following table summarizes the main causes of knee joint pain. the centre of which becomes expanded. CT scans may show changes in the patellar ligament. The term ‘jumper’s knee’ is used to describe a number of conditions where there is pain in the patellar ligament or its insertion: it includes the Sinding–Larsen–Johansson syndrome.
Meniscal Injury Ligament Injury Fracture Dislocations Overuse Injury ++ ++ ++ +++ ++ + + + + +++ + Rheumatological Rheumatoid Arthritis Ankylosing Spondylitis Psoriatic Arthritis + + ++ ++ ++++ +++ + ++ + + ++ Infections Tuberculous Bacterial + + + + + ++ +++ + Metabolic Disorders Rickets Osteoporosis Gout Osteomalacia + + ++ +++ +++ ++++ + + ++ +++ ++ + + + + + + +++ Steroid induced ++ Pagets disease Pseudogout + + + ++++ Haemoglobinopathies Bleeding disorders Haemophillia ++ + + ++ +++ + Congenital anomalies Tibia Vara (Bow-legs) Genu varum (Bow-legs) Genu Valgum (Knock knees) + + + ++ ++ + +++ +++ +++ + + + Tumors (Bony/Synovial) Benign + +++ ++ .
669 619 619 610 600 589 589 580 580 4 2 1 4 1 2 1 1 1 4 2 4 2 1 1 1 2 1 . lyc. in various repertories - rhus-t. calc. phos. led. agar. thuj. zinc. sil. 72/100 67/100 58/100 53/100 50/10 47/100 42/100 42/100 41/100 Miasmatic analysis (done with Synthesis 9. kali-c. ars.2) - Remedy Miasm 730 Psora 2 Sycosis 4 nit-ac. kali-i. coloc. 92/100 sulph.Malignant Metastatic + ++ +++ +++ ++ + +++ ++++ Homoeopathic TreatmentFrequently indicated remedies for Knee Pain in decreasing prominence according to the rubrics found. sulph. aur. in general. caust.2) of disorders with Knee pain – Psora 75 % Sycosis 62 % Syphilis 65 % Pseudopsora 64 % Cancerous 83 % Top ten antimiasmatic remedies (Synthesis 9. merc. lyc.
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