Management of De Quervain’s Tenosynovitis with Agnikarma – A Case Report

Abstract

De Quervain’s tenosynovitis is a painful condition in which common tendon sheath of abductor pollicis longus and extensor pollicis brevis is inflamed or thickened, about 3.25 cm proximal to the tip of radial styloid process on the lateral aspect of wrist. It leads to narrowing of the intrathecal lumen.[i] It can result due to repetitive stress, hormonal influence, rheumatoid disease, trauma or degenerative changes. Females are more affected than males. The clinical features include pain on lateral aspect of wrist that is increased on extension and abduction movements of the thumb. Pain may progress in severity to an extent of significant disability. Splinting of the thumb, injection of corticosteroids into the tendon sheath and surgical release of the first dorsal compartment are adopted in the contemporary medical science to manage it. In Ayurveda, the infliction of Ruja (pain) and Karma Kshaya (diminution in the normal activity/disability) has been attributed to vitiation of Vata Dosha. Excessively painful conditions of bones, joints, muscles, tendons and ligaments constitute the indications for Agnikarma (therapeutic heating).

In this case study, a 52 years old female who was a housewife, visited the outdoor patient department (OPD) of Shalya Tantra at hospital of National Institute of Ayurveda (NIA), Jaipur, Rajasthan, India. She presented with the chief complaints of having severe pain at the radial side of the right wrist with difficulty in performing household work for the last six months. On palpation, there was tenderness at the site with a feebly palpable swelling. The Finkelstein’s test was positive. This case was managed with conductive method of Agnikarma using a Swarna Shalaka (rod made up of 14 K gold) with positive outcomes. This case study is presented here to emphasize the applicability of a traditional pain management therapy viz. Agnikarma in modern clinical practice.